ROMAN V KLODNYCKY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****45

License Status

NOT RENEWED

Business

Title

First Name

ROMAN V

Last Name

KLODNYCKY

Business Name

ROMAN V KLODNYCKY OD

Original Issue Date

01/16/2002

Effective Date

03/08/2010

Expiration Date

03/31/2012

City

PEORIA

State

Zip

61613

County

PEORIA

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/16/2012