RABIA N J ANSARI OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****76

License Status

NOT RENEWED

Business

First Name

RABIA

Middle

N J

Last Name

ANSARI

Suffix

Business Name

RABIA N J ANSARI OD

Original Issue Date

02/23/2005

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/02/2008