CHARLES BAILEY GOODMAN Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****21

License Status

NOT RENEWED

Business

First Name

CHARLES

Middle

BAILEY

Last Name

GOODMAN

Business Name

CHARLES BAILEY GOODMAN

Original Issue Date

04/09/2007

Effective Date

05/23/2018

Expiration Date

09/30/2020

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/14/2021