KENNETH E CLARK Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****68

License Status

NOT RENEWED

Business

First Name

KENNETH E

Last Name

CLARK

Business Name

KENNETH E CLARK

Original Issue Date

05/30/1996

Effective Date

03/12/2020

Expiration Date

05/31/2022

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022