SAM DAVID BAKER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930641

License Status

NOT RENEWED

Business

First Name

SAM

Middle

DAVID

Last Name

BAKER

Suffix

Business Name

SAM DAVID BAKER OD

Original Issue Date

10/04/2004

Effective Date

10/04/2004

Expiration Date

03/31/2006

City

LAKE BLUFF

State

Zip

60044

County

LAKE

Ever Disciplined

LastModifiedDate

05/11/2006