SAM DAVID BAKER OD - Optometrist License in Illinois | # 047930641

SAM DAVID BAKER OD

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930641

License Status

NOT RENEWED

Business

N

First Name

SAM

Middle

DAVID

Last Name

BAKER

Suffix

OD

Business Name

SAM DAVID BAKER OD

Original Issue Date

10/04/2004

Effective Date

10/04/2004

Expiration Date

03/31/2006

State

IL

Ever Disciplined

N

LastModifiedDate

05/11/2006