MARCIA E BLAKE 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

MARCIA E

Last Name

BLAKE

Business Name

MARCIA E BLAKE

Original Issue Date

08/09/1996

Effective Date

03/30/2022

Expiration Date

03/31/2024

City

CHICAGO

State

Zip

60643

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/05/2025