JEFFREY J BLANCO OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****91

License Status

CANCELLED

Business

First Name

JEFFREY

Middle

Last Name

BLANCO

Suffix

Business Name

JEFFREY J BLANCO OD

Original Issue Date

08/15/1996

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

SPRING VALLEY

State

Zip

61362

County

BUREAU

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

12/18/2008