LEO J PRENTICE Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****82

License Status

NOT RENEWED

Business

First Name

LEO J

Last Name

PRENTICE

Business Name

LEO J PRENTICE

Original Issue Date

09/16/1996

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

BRAIDWOOD

State

Zip

60408

County

WILL

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/18/2006