SUSAN ANDREA SEABOLD 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

SUSAN

Middle

ANDREA

Last Name

SEABOLD

Business Name

SUSAN ANDREA SEABOLD

Original Issue Date

07/16/2009

Effective Date

02/03/2010

Expiration Date

03/31/2012

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/16/2012