THEODORE E BOGART OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****68

License Status

NOT RENEWED

Business

First Name

THEODORE

Middle

Last Name

BOGART

Suffix

Business Name

THEODORE E BOGART OD

Original Issue Date

04/12/1996

Effective Date

02/24/2016

Expiration Date

03/31/2018

City

SHELBYVILLE

State

Zip

62565

County

SHELBY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018