JACK MALLEN Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047004199

License Status

NOT RENEWED

Business

First Name

JACK

Last Name

MALLEN

Business Name

JACK MALLEN

Original Issue Date

09/29/1978

Expiration Date

01/01/1997

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

09/01/2005