MARK D WADE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****77

License Status

NOT RENEWED

Business

Title

First Name

MARK

Middle

Last Name

WADE

Business Name

MARK D WADE OD

Original Issue Date

07/25/2018

Effective Date

07/25/2018

Expiration Date

09/30/2020

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021