J ROBERT FULTS 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

Middle

ROBERT

Last Name

FULTS

Suffix

Business Name

J ROBERT FULTS OD

Original Issue Date

09/04/2008

Effective Date

03/22/2018

Expiration Date

09/30/2020

City

BROADWELL

State

Zip

62634

County

LOGAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021