JAMES MITCHELL POLONCAK Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****71

License Status

INACTIVE

Business

First Name

JAMES

Middle

MITCHELL

Last Name

POLONCAK

Business Name

JAMES MITCHELL POLONCAK

Original Issue Date

08/27/2001

Effective Date

03/11/2004

Expiration Date

03/31/2004

City

MOUNT PROSPECT

State

Zip

60056

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006