ALEX R TAN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930624

License Status

NOT RENEWED

Business

First Name

ALEX

Middle

Last Name

TAN

Suffix

Business Name

ALEX R TAN OD

Original Issue Date

09/30/2004

Effective Date

09/30/2004

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60609

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006