JAY R EBBESEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****47

License Status

NOT RENEWED

Business

First Name

JAY

Middle

Last Name

EBBESEN

Suffix

Business Name

JAY R EBBESEN OD

Original Issue Date

04/14/1998

Effective Date

03/09/2022

Expiration Date

03/31/2024

City

DEKALB

State

Zip

60115

County

DEKALB

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025