LISA MARIE BINGHAM OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****34

License Status

CANCELLED

Business

First Name

LISA

Middle

MARIE

Last Name

BINGHAM

Suffix

Business Name

LISA MARIE BINGHAM OD

Original Issue Date

07/19/2010

Effective Date

07/19/2010

Expiration Date

03/31/2012

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/12/2012