BETHANY MARIE LEWALLEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****66

License Status

NOT RENEWED

Business

First Name

BETHANY

Middle

MARIE

Last Name

LEWALLEN

Suffix

Business Name

BETHANY MARIE LEWALLEN OD

Original Issue Date

10/28/1998

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

CHICAGO

State

Zip

60646

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005