ANDREW THOMAS CLARK OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931366

License Status

CANCELLED

Business

First Name

ANDREW

Middle

THOMAS

Last Name

CLARK

Suffix

Business Name

ANDREW THOMAS CLARK OD

Original Issue Date

08/12/2005

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/04/2010