QUENTIN GIN PARK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930592

License Status

NOT RENEWED

Business

First Name

QUENTIN

Middle

GIN

Last Name

PARK

Suffix

Business Name

QUENTIN GIN PARK OD

Original Issue Date

09/16/2004

Effective Date

09/16/2004

Expiration Date

03/31/2006

City

NAPERVILLE

State

Zip

60564

County

WILL

Ever Disciplined

LastModifiedDate

05/11/2006