CANAAN MATTHEW MONTGOMERY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****97

License Status

NOT RENEWED

Business

Title

First Name

CANAAN

Middle

MATTHEW

Last Name

MONTGOMERY

Business Name

CANAAN MATTHEW MONTGOMERY OD

Original Issue Date

08/14/2014

Effective Date

02/24/2016

Expiration Date

03/31/2018

City

VIENNA

State

Zip

62995

County

JOHNSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018