T DANE SHELLEY OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047006644

License Status

CANCELLED

Business

First Name

Middle

DANE

Last Name

SHELLEY

Suffix

Business Name

T DANE SHELLEY OD

Original Issue Date

09/17/1976

Expiration Date

01/01/1997

City

CHICAGO

State

Zip

60634

County

COOK

Ever Disciplined

LastModifiedDate

09/01/2005