E DALE BROCK Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****92

License Status

NOT RENEWED

Business

First Name

E DALE

Last Name

BROCK

Business Name

E DALE BROCK

Original Issue Date

05/30/1996

Effective Date

02/04/2016

Expiration Date

03/31/2018

City

WEST FRANKFORT

State

Zip

62896

County

FRANKLIN

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018