THOMAS E GUSTAFSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047038241

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

GUSTAFSON

Suffix

Business Name

THOMAS E GUSTAFSON OD

Original Issue Date

11/14/1996

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

LAKE ZURICH

State

Zip

60047

County

LAKE

Ever Disciplined

LastModifiedDate

09/11/2005