DAISY QIWEN CHAN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928960

License Status

NOT RENEWED

Business

First Name

DAISY

Middle

QIWEN

Last Name

CHAN

Suffix

Business Name

DAISY QIWEN CHAN OD

Original Issue Date

09/06/2002

Effective Date

03/15/2004

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60616

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006