JAY CHARLES BLACK Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046006709

License Status

NOT RENEWED

Business

First Name

JAY CHARLES

Last Name

BLACK

Business Name

JAY CHARLES BLACK

Original Issue Date

07/18/1975

Effective Date

03/12/2020

Expiration Date

05/31/2022

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/27/2022