ELILTA BEREKETAB OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****91

License Status

NOT RENEWED

Business

First Name

ELILTA

Last Name

BEREKETAB

Suffix

Business Name

ELILTA BEREKETAB OD

Original Issue Date

08/08/2003

Effective Date

03/14/2018

Expiration Date

09/30/2020

City

PINCKNEYVILLE

State

Zip

62274

County

PERRY

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021