SHASA TB DABNER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046009393

License Status

NOT RENEWED

Business

First Name

SHASA

Middle

Last Name

DABNER

Suffix

Business Name

SHASA TB DABNER OD

Original Issue Date

08/06/2001

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

CHICAGO

State

Zip

60619

County

COOK

Ever Disciplined

LastModifiedDate

11/15/2005