THOMAS K BIALECKE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****78

License Status

NOT RENEWED

Business

Title

First Name

THOMAS

Middle

Last Name

BIALECKE

Business Name

THOMAS K BIALECKE OD

Original Issue Date

06/17/1996

Effective Date

03/21/2012

Expiration Date

03/31/2014

City

OREGON

State

Zip

61061

County

OGLE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014