NORMAN E BLASE OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926363

License Status

CANCELLED

Business

First Name

NORMAN

Middle

Last Name

BLASE

Suffix

Business Name

NORMAN E BLASE OD

Original Issue Date

09/03/1999

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010