MANDEL M BERG Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****33

License Status

CANCELLED

Business

First Name

MANDEL

Middle

Last Name

BERG

Business Name

MANDEL M BERG

Original Issue Date

09/20/2004

Effective Date

10/18/2004

Expiration Date

03/31/2006

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006