JOSEPH L LONG OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****58

License Status

NOT RENEWED

Business

First Name

JOSEPH

Middle

Last Name

LONG

Suffix

Business Name

JOSEPH L LONG OD

Original Issue Date

11/21/1996

Effective Date

02/14/2012

Expiration Date

03/31/2014

City

BOURBONNAIS

State

Zip

60914

County

KANKAKEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014