GREGORY MANGANTULAO MACAGBA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****24

License Status

NOT RENEWED

Business

Title

First Name

GREGORY

Middle

MANGANTULAO

Last Name

MACAGBA

Business Name

GREGORY MANGANTULAO MACAGBA OD

Original Issue Date

11/19/2018

Effective Date

03/11/2020

Expiration Date

05/31/2022

City

MANTENO

State

Zip

60950

County

KANKAKEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022