MANDEL M BERG Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928360

License Status

CANCELLED

Business

First Name

MANDEL

Middle

Last Name

BERG

Business Name

MANDEL M BERG

Original Issue Date

01/09/2002

Effective Date

10/18/2004

Expiration Date

03/31/2006

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Ever Disciplined

LastModifiedDate

09/01/2005