MICHAEL G BLAKE Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046006710

License Status

INACTIVE

Business

First Name

MICHAEL G

Last Name

BLAKE

Business Name

MICHAEL G BLAKE

Original Issue Date

07/18/1975

Expiration Date

03/31/1986

City

GALLUP

State

Zip

87301

County

NEW MEXICO

Ever Disciplined

LastModifiedDate

08/31/2005