JOSEPH MICHAEL FAGELMAN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****51

License Status

NOT RENEWED

Business

First Name

JOSEPH

Middle

MICHAEL

Last Name

FAGELMAN

Suffix

Business Name

JOSEPH MICHAEL FAGELMAN OD

Original Issue Date

08/16/2001

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005