RUSSELL HOWARD FARSON 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

RUSSELL HOWARD

Last Name

FARSON

Business Name

RUSSELL HOWARD FARSON

Original Issue Date

05/30/1996

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005