ANDREW THOMAS CLARK OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047307654

License Status

CANCELLED

Business

First Name

ANDREW

Middle

THOMAS

Last Name

CLARK

Suffix

Business Name

ANDREW THOMAS CLARK OD

Original Issue Date

07/26/1991

Expiration Date

03/31/1994

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/01/2005