JON W RUSSELL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****73

License Status

NOT RENEWED

Business

First Name

JON

Middle

Last Name

RUSSELL

Suffix

Business Name

JON W RUSSELL OD

Original Issue Date

08/26/2005

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/28/2014