GREGORY D JACKSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930392

License Status

NOT RENEWED

Business

First Name

GREGORY

Middle

Last Name

JACKSON

Suffix

Business Name

GREGORY D JACKSON OD

Original Issue Date

07/07/2004

Effective Date

07/07/2004

Expiration Date

03/31/2006

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006