KELLY P GREEN Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****24

License Status

INACTIVE

Business

First Name

KELLY P

Last Name

GREEN

Business Name

KELLY P GREEN

Original Issue Date

04/08/1996

Effective Date

03/24/2004

Expiration Date

03/31/2004

City

SPRINGFIELD

State

Zip

65802

County

MISSOURI

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005