ERIC JOHN LEAVITT OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****64

License Status

NOT RENEWED

Business

Title

First Name

ERIC

Middle

JOHN

Last Name

LEAVITT

Business Name

ERIC JOHN LEAVITT OD

Original Issue Date

04/12/2010

Effective Date

04/02/2012

Expiration Date

03/31/2014

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014