KATHERINE A BLASKOVICH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****63

License Status

NOT RENEWED

Business

First Name

KATHERINE

Middle

Last Name

BLASKOVICH

Suffix

Business Name

KATHERINE A BLASKOVICH OD

Original Issue Date

03/14/2000

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

TINLEY PARK

State

Zip

60477

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005