ROSS W MLSNA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****32

License Status

NOT RENEWED

Business

First Name

ROSS

Middle

Last Name

MLSNA

Suffix

Business Name

ROSS W MLSNA OD

Original Issue Date

07/25/2005

Effective Date

03/22/2010

Expiration Date

03/31/2012

City

CHICAGO

State

Zip

60638

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/16/2012