ROBERT EDWARD FISCH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****41

License Status

NOT RENEWED

Business

Title

First Name

ROBERT

Middle

EDWARD

Last Name

FISCH

Business Name

ROBERT EDWARD FISCH OD

Original Issue Date

10/24/1996

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006