JAY CHARLES BLACK Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****89

License Status

NOT RENEWED

Business

First Name

JAY CHARLES

Last Name

BLACK

Business Name

JAY CHARLES BLACK

Original Issue Date

04/04/2005

Effective Date

03/19/2014

Expiration Date

03/31/2016

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016