MARTHA SUE SMITH OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****56

License Status

CANCELLED

Business

First Name

MARTHA

Middle

SUE

Last Name

SMITH

Suffix

Business Name

MARTHA SUE SMITH OD

Original Issue Date

10/24/1997

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

EAST DUBUQUE

State

Zip

61025

County

JO DAVIESS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

02/05/2008