VAN D PHAM OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047925674

License Status

NOT RENEWED

Business

First Name

VAN D

Last Name

PHAM

Suffix

Business Name

VAN D PHAM OD

Original Issue Date

05/26/1998

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/11/2005