JEFFREY J BLANCO OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****56

License Status

CANCELLED

Business

First Name

JEFFREY

Middle

Last Name

BLANCO

Suffix

Business Name

JEFFREY J BLANCO OD

Original Issue Date

05/13/1998

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

OTTAWA

State

Zip

61350

County

LA SALLE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

03/13/2008