T DANE SHELLEY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****78

License Status

NOT RENEWED

Business

First Name

Middle

DANE

Last Name

SHELLEY

Suffix

Business Name

T DANE SHELLEY OD

Original Issue Date

09/21/1999

Effective Date

03/05/2020

Expiration Date

05/31/2022

City

PEKIN

State

Zip

61554

County

TAZEWELL

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022