MICHAEL ANGELO BERTUCCI OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****54

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

ANGELO

Last Name

BERTUCCI

Suffix

Business Name

MICHAEL ANGELO BERTUCCI OD

Original Issue Date

11/19/2004

Effective Date

11/19/2004

Expiration Date

03/31/2006

City

DES PLAINES

State

Zip

60018

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006