KRISTEN NICOLE CLARK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****07

License Status

NOT RENEWED

Business

First Name

KRISTEN

Middle

NICOLE

Last Name

CLARK

Suffix

Business Name

KRISTEN NICOLE CLARK OD

Original Issue Date

06/28/2011

Effective Date

03/10/2014

Expiration Date

03/31/2016

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/20/2016