MARC LEE BRAITHWAITE Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****35

License Status

NOT RENEWED

Business

First Name

MARC

Middle

LEE

Last Name

BRAITHWAITE

Business Name

MARC LEE BRAITHWAITE

Original Issue Date

05/06/2003

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005