TARA NICOLE VAN DE WYNGAERDE OD - Optometrist License in Illinois | # 047933638

TARA NICOLE VAN DE WYNGAERDE OD

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933638

License Status

CANCELLED

Business

N

First Name

TARA

Middle

NICOLE

Last Name

VAN DE WYNGAERDE

Suffix

OD

Business Name

TARA NICOLE VAN DE WYNGAERDE OD

Original Issue Date

12/18/2007

Effective Date

01/10/2008

Expiration Date

03/31/2010

State

IL

Ever Disciplined

N

LastModifiedDate

05/04/2010