BRADLEY ELLIOTT BORELLO OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****63

License Status

NOT RENEWED

Business

Title

First Name

BRADLEY

Middle

ELLIOTT

Last Name

BORELLO

Business Name

BRADLEY ELLIOTT BORELLO OD

Original Issue Date

07/21/2009

Effective Date

07/21/2009

Expiration Date

03/31/2010

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010