HARVEY D MACK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****81

License Status

NOT RENEWED

Business

First Name

HARVEY

Middle

Last Name

MACK

Suffix

Business Name

HARVEY D MACK OD

Original Issue Date

06/20/2006

Effective Date

01/12/2018

Expiration Date

09/30/2020

City

BEARDSTOWN

State

Zip

62618

County

CASS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/14/2021