JASON EVAN BRAND OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****39

License Status

NOT RENEWED

Business

First Name

JASON

Middle

EVAN

Last Name

BRAND

Suffix

Business Name

JASON EVAN BRAND OD

Original Issue Date

05/07/2008

Effective Date

01/25/2012

Expiration Date

03/31/2014

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/06/2014