BLAIR TANAKA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047927271

License Status

NOT RENEWED

Business

First Name

BLAIR

Last Name

TANAKA

Suffix

Business Name

BLAIR TANAKA OD

Original Issue Date

07/07/2000

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/11/2005