JEDIDIAH DAVID SMITH 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

JEDIDIAH

Middle

DAVID

Last Name

SMITH

Business Name

JEDIDIAH DAVID SMITH

Original Issue Date

04/13/2015

Effective Date

04/13/2015

Expiration Date

03/31/2016

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016