NORMAN E BLASE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****42

License Status

NOT RENEWED

Business

First Name

NORMAN

Middle

Last Name

BLASE

Suffix

Business Name

NORMAN E BLASE OD

Original Issue Date

03/26/1998

Effective Date

02/23/2016

Expiration Date

03/31/2018

City

MELROSE PARK

State

Zip

60160

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018