BRIAN RICHARD BENITZ OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****62

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

RICHARD

Last Name

BENITZ

Suffix

Business Name

BRIAN RICHARD BENITZ OD

Original Issue Date

09/03/1999

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005