License holder summary

Jack Lee Black is a Optometric Legend Drug Certificate licensed to practice in Indiana. The address on file for Jack Lee Black is Fort Wayne IN 46804-4839. This licensed professional license is current. The license was granted 02/11/1993 and expired on 04/01/2016.

Indiana

Professional Licensing Agency

Jack Lee Black
Optometric Legend Drug Certificate
License number
18001371B
Date granted
02/11/1993
Date expires
04/01/2016
Class
Optometric Legend Drug Certificate
Status
Active
Address
Fort Wayne IN 46804-4839
indianalicensing.org
ID 8284631
LAST UPDATED 2024-02-22 16:06:53 UTC

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