DAVID RAY HAISMAN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****36

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

RAY

Last Name

HAISMAN

Suffix

Business Name

DAVID RAY HAISMAN OD

Original Issue Date

05/01/2008

Effective Date

05/01/2008

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010