JASON PETTERSON FRONK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****42

License Status

NOT RENEWED

Business

First Name

JASON

Middle

PETTERSON

Last Name

FRONK

Suffix

Business Name

JASON PETTERSON FRONK OD

Original Issue Date

09/06/2000

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005