GARY D DISTIN Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****34

License Status

NOT RENEWED

Business

First Name

GARY D

Last Name

DISTIN

Business Name

GARY D DISTIN

Original Issue Date

04/11/1996

Effective Date

03/26/2018

Expiration Date

09/30/2020

City

MONMOUTH

State

Zip

61462

County

WARREN

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021