TRACY ANN HEIDENREICH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****25

License Status

NOT RENEWED

Business

First Name

TRACY

Middle

ANN

Last Name

HEIDENREICH

Suffix

Business Name

TRACY ANN HEIDENREICH OD

Original Issue Date

09/25/1997

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005