WAYNE MARK FORMAN Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046007414

License Status

INACTIVE

Business

First Name

WAYNE MARK

Last Name

FORMAN

Business Name

WAYNE MARK FORMAN

Original Issue Date

08/10/1981

Expiration Date

03/31/1984

City

FOREST HILLS

State

Zip

11375

County

NEW YORK

Ever Disciplined

LastModifiedDate

08/31/2005