SAM DAVID BAKER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930419

License Status

NOT RENEWED

Business

First Name

SAM

Middle

DAVID

Last Name

BAKER

Suffix

Business Name

SAM DAVID BAKER OD

Original Issue Date

08/12/2004

Effective Date

08/12/2004

Expiration Date

03/31/2006

City

WARRENVILLE

State

Zip

60555

County

DUPAGE

Ever Disciplined

LastModifiedDate

05/11/2006