DANIEL J MEDEMA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047927894

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

Last Name

MEDEMA

Suffix

Business Name

DANIEL J MEDEMA OD

Original Issue Date

05/14/2001

Effective Date

06/23/2004

Expiration Date

03/31/2006

City

ROUND LAKE BEACH

State

Zip

60073

County

LAKE

Ever Disciplined

LastModifiedDate

05/11/2006