ANWI NGANDO ETAME OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****98

License Status

NOT RENEWED

Business

First Name

ANWI

Middle

NGANDO

Last Name

ETAME

Suffix

Business Name

ANWI NGANDO ETAME OD

Original Issue Date

07/30/2007

Effective Date

01/12/2018

Expiration Date

09/30/2020

City

GENESEO

State

Zip

61254

County

HENRY

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021