CHAD R BAKER Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****90

License Status

NOT RENEWED

Business

First Name

CHAD

Middle

Last Name

BAKER

Business Name

CHAD R BAKER

Original Issue Date

07/17/2007

Effective Date

02/20/2020

Expiration Date

05/31/2022

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022