SHAIROZ A FAZAL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929478

License Status

NOT RENEWED

Business

First Name

SHAIROZ

Middle

Last Name

FAZAL

Suffix

Business Name

SHAIROZ A FAZAL OD

Original Issue Date

05/28/2003

Effective Date

05/28/2003

Expiration Date

03/31/2004

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005