BLAIR TANAKA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930677

License Status

NOT RENEWED

Business

First Name

BLAIR

Last Name

TANAKA

Suffix

Business Name

BLAIR TANAKA OD

Original Issue Date

10/08/2004

Effective Date

10/08/2004

Expiration Date

03/31/2006

City

EVERGREEN PARK

State

Zip

60805

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006