ANDREW THOMAS CLARK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****79

License Status

NOT RENEWED

Business

First Name

ANDREW

Middle

THOMAS

Last Name

CLARK

Suffix

Business Name

ANDREW THOMAS CLARK OD

Original Issue Date

06/17/1996

Effective Date

01/21/2020

Expiration Date

05/31/2022

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022