BREEZE EVELYN BELLEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****24

License Status

NOT RENEWED

Business

First Name

BREEZE

Middle

EVELYN

Last Name

BELLEN

Suffix

Business Name

BREEZE EVELYN BELLEN OD

Original Issue Date

07/15/2005

Effective Date

07/15/2005

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006