BRUCE ALLAN TEITELBAUM OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****93

License Status

NOT RENEWED

Business

First Name

BRUCE

Middle

ALLAN

Last Name

TEITELBAUM

Suffix

Business Name

BRUCE ALLAN TEITELBAUM OD

Original Issue Date

06/10/1996

Effective Date

01/18/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021