CASEY JAMES CRUMBLISS OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****60

License Status

NOT RENEWED

Business

First Name

CASEY

Middle

JAMES

Last Name

CRUMBLISS

Suffix

Business Name

CASEY JAMES CRUMBLISS OD

Original Issue Date

08/04/2003

Effective Date

03/25/2004

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006