SHAIROZ A FAZAL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930947

License Status

NOT RENEWED

Business

First Name

SHAIROZ

Middle

Last Name

FAZAL

Suffix

Business Name

SHAIROZ A FAZAL OD

Original Issue Date

03/10/2005

Effective Date

03/10/2005

Expiration Date

03/31/2006

City

LOMBARD

State

Zip

60148

County

DUPAGE

Ever Disciplined

LastModifiedDate

05/11/2006