JUSTIN WILLIAM JOHNSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****53

License Status

NOT RENEWED

Business

Title

First Name

JUSTIN

Middle

WILLIAM

Last Name

JOHNSON

Business Name

JUSTIN WILLIAM JOHNSON OD

Original Issue Date

04/18/2019

Effective Date

04/18/2019

Expiration Date

09/30/2020

City

BELVIDERE

State

Zip

61008

County

BOONE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021