THOMAS E GUSTAFSON OD - Optometrist License in Illinois | # 047038241

THOMAS E GUSTAFSON OD

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047038241

License Status

NOT RENEWED

Business

N

First Name

THOMAS

Middle

E

Last Name

GUSTAFSON

Suffix

OD

Business Name

THOMAS E GUSTAFSON OD

Original Issue Date

11/14/1996

Effective Date

06/04/2004

Expiration Date

03/31/2004

State

IL

Ever Disciplined

N

LastModifiedDate

09/11/2005