JONATHAN D GOULART OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****54

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

Last Name

GOULART

Suffix

Business Name

JONATHAN D GOULART OD

Original Issue Date

03/22/2016

Effective Date

01/22/2018

Expiration Date

09/30/2020

City

OREGON

State

Zip

61061

County

STEPHENSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021