PHILIP A ORTIZ OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****53

License Status

NOT RENEWED

Business

First Name

PHILIP

Middle

Last Name

ORTIZ

Suffix

Business Name

PHILIP A ORTIZ OD

Original Issue Date

09/20/1996

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

MORRIS

State

Zip

60450

County

GRUNDY

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006