MICHELLE E BERTENTHAL Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****59

License Status

NOT RENEWED

Business

First Name

MICHELLE E

Last Name

BERTENTHAL

Business Name

MICHELLE E BERTENTHAL

Original Issue Date

04/08/1996

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

FORSYTH

State

Zip

62535

County

MACON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005