JULIE A DOMBEK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****82

License Status

NOT RENEWED

Business

Title

First Name

JULIE

Middle

Last Name

DOMBEK

Business Name

JULIE A DOMBEK OD

Original Issue Date

10/25/2011

Effective Date

06/06/2012

Expiration Date

03/31/2014

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014