JACOB LEO STALLBAUMER Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****95

License Status

NOT RENEWED

Business

First Name

JACOB

Middle

LEO

Last Name

STALLBAUMER

Business Name

JACOB LEO STALLBAUMER

Original Issue Date

08/24/2018

Effective Date

05/20/2022

Expiration Date

03/31/2024

City

CHICAGO

State

Zip

60647

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025