JASON RICHARD DIEHL OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****30

License Status

CANCELLED

Business

Title

First Name

JASON

Middle

RICHARD

Last Name

DIEHL

Business Name

JASON RICHARD DIEHL OD

Original Issue Date

11/03/2003

Effective Date

12/16/2010

Expiration Date

03/31/2012

City

GLEN CARBON

State

Zip

62034

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/03/2011