ROGER N BLANK Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****43

License Status

NOT RENEWED

Business

First Name

ROGER N

Last Name

BLANK

Business Name

ROGER N BLANK

Original Issue Date

07/31/1996

Effective Date

01/04/2020

Expiration Date

05/31/2022

City

WHEELING

State

Zip

60090

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022