MARK A ELLISON Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****99

License Status

NOT RENEWED

Business

First Name

MARK A

Last Name

ELLISON

Business Name

MARK A ELLISON

Original Issue Date

05/07/1996

Effective Date

03/12/2022

Expiration Date

03/31/2024

City

BETHALTO

State

Zip

62010

County

MADISON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025