LEXI A DERRY 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

LEXI

Middle

Last Name

DERRY

Suffix

Business Name

LEXI A DERRY OD

Original Issue Date

08/11/2011

Effective Date

03/21/2016

Expiration Date

03/31/2018

City

FAIRBURY

State

Zip

61739

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018