LISA B DIBLER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****96

License Status

NOT RENEWED

Business

First Name

LISA

Middle

Last Name

DIBLER

Suffix

Business Name

LISA B DIBLER OD

Original Issue Date

04/11/1997

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006