HARVEY D MACK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****85

License Status

NOT RENEWED

Business

First Name

HARVEY

Middle

Last Name

MACK

Suffix

Business Name

HARVEY D MACK OD

Original Issue Date

11/19/1996

Effective Date

03/13/2008

Expiration Date

03/31/2010

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010