LAURIE A RUNNERSTROM Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****72

License Status

NOT RENEWED

Business

First Name

LAURIE A

Last Name

RUNNERSTROM

Business Name

LAURIE A RUNNERSTROM

Original Issue Date

08/20/1996

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

SAINT CHARLES

State

Zip

60174

County

KANE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006