BLAIR TANAKA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926434

License Status

NOT RENEWED

Business

First Name

BLAIR

Last Name

TANAKA

Suffix

Business Name

BLAIR TANAKA OD

Original Issue Date

10/13/1999

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

CHICAGO

State

Zip

60623

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005