SHAYMA R ANSARI OD - Optometrist License in Illinois | # 34*****34

SHAYMA R ANSARI OD

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****34

License Status

CANCELLED

Business

N

First Name

SHAYMA

Middle

R

Last Name

ANSARI

Suffix

OD

Business Name

SHAYMA R ANSARI OD

Original Issue Date

11/06/2003

Effective Date

06/04/2004

Expiration Date

03/31/2004

State

IL

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

IV

Ever Disciplined

N

LastModifiedDate

01/18/2006