JEFFREY EDWIN MONTGOMERY Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****50

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

EDWIN

Last Name

MONTGOMERY

Business Name

JEFFREY EDWIN MONTGOMERY

Original Issue Date

08/16/2001

Effective Date

03/08/2004

Expiration Date

03/31/2006

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006