MIRIAM M WELLER Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930704

License Status

NOT RENEWED

Business

First Name

MIRIAM

Middle

Last Name

WELLER

Business Name

MIRIAM M WELLER

Original Issue Date

10/29/2004

Effective Date

10/29/2004

Expiration Date

03/31/2006

City

MOUNT PROSPECT

State

Zip

60056

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006