ANISHA JACOB OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****80

License Status

NOT RENEWED

Business

Title

First Name

ANISHA

Last Name

JACOB

Business Name

ANISHA JACOB OD

Original Issue Date

10/03/2012

Effective Date

01/22/2014

Expiration Date

03/31/2016

City

STERLING

State

Zip

61081

County

WHITESIDE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016