BRIAN M ROSS OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****84

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

ROSS

Suffix

Business Name

BRIAN M ROSS OD

Original Issue Date

03/24/2005

Effective Date

03/24/2005

Expiration Date

03/31/2006

City

ROBINSON

State

Zip

62454

County

CRAWFORD

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/11/2006