SARAH REBECCA BURGETT OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****86

License Status

NOT RENEWED

Business

Title

First Name

SARAH

Middle

REBECCA

Last Name

BURGETT

Business Name

SARAH REBECCA BURGETT OD

Original Issue Date

10/22/2012

Effective Date

10/22/2012

Expiration Date

03/31/2014

City

KEWANEE

State

Zip

61443

County

HENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014