BRUCE MICHAEL PORTNOY Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****45

License Status

NOT RENEWED

Business

First Name

BRUCE MICHAEL

Last Name

PORTNOY

Business Name

BRUCE MICHAEL PORTNOY

Original Issue Date

10/02/1996

Effective Date

04/20/2012

Expiration Date

03/31/2014

City

INDIAN CREEK

State

Zip

60061

County

LAKE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/09/2014