MATTHEW ROGER DE GROOT OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929737

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

ROGER

Last Name

DE GROOT

Suffix

Business Name

MATTHEW ROGER DE GROOT OD

Original Issue Date

09/29/2003

Effective Date

02/25/2004

Expiration Date

03/31/2006

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006