RICHARD MARK ZAJICEK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****15

License Status

NOT RENEWED

Business

Title

First Name

RICHARD MARK

Last Name

ZAJICEK

Business Name

RICHARD MARK ZAJICEK OD

Original Issue Date

04/22/1996

Effective Date

03/01/2010

Expiration Date

03/31/2012

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/16/2012