FREDERICK J FAGAN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928083

License Status

NOT RENEWED

Business

First Name

FREDERICK J

Last Name

FAGAN

Suffix

Business Name

FREDERICK J FAGAN OD

Original Issue Date

08/21/2001

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

NORTHLAKE

State

Zip

60164

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005