MANDEL M BERG Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****88

License Status

NOT RENEWED

Business

First Name

MANDEL

Middle

Last Name

BERG

Business Name

MANDEL M BERG

Original Issue Date

12/05/2000

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

NILES

State

Zip

60714

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006