RANDALL D BURGGRAF 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

RANDALL

Middle

Last Name

BURGGRAF

Suffix

Business Name

RANDALL D BURGGRAF OD

Original Issue Date

06/18/1996

Effective Date

02/10/2015

Expiration Date

03/31/2016

City

DE KALB

State

Zip

60115

County

DEKALB

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016