SHASA TB DABNER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928176

License Status

NOT RENEWED

Business

First Name

SHASA

Middle

Last Name

DABNER

Suffix

Business Name

SHASA TB DABNER OD

Original Issue Date

09/27/2001

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

CHICAGO

State

Zip

60604

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005