JONATHAN EDWARD MICETICH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****78

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

EDWARD

Last Name

MICETICH

Suffix

Business Name

JONATHAN EDWARD MICETICH OD

Original Issue Date

07/21/1997

Effective Date

01/12/2000

Expiration Date

03/31/1998

City

BOURBONNAIS

State

Zip

60914

County

KANKAKEE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006