JAMES MITCHELL POLONCAK Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****72

License Status

INACTIVE

Business

First Name

JAMES

Middle

MITCHELL

Last Name

POLONCAK

Business Name

JAMES MITCHELL POLONCAK

Original Issue Date

03/14/2002

Effective Date

03/11/2004

Expiration Date

03/31/2004

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006