MANDEL M BERG Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****89

License Status

CANCELLED

Business

First Name

MANDEL

Middle

Last Name

BERG

Business Name

MANDEL M BERG

Original Issue Date

12/05/2000

Effective Date

03/16/2004

Expiration Date

03/31/2006

City

BUFFALO GROVE

State

Zip

60089

County

LAKE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006