SAM DAVID BAKER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931185

License Status

NOT RENEWED

Business

First Name

SAM

Middle

DAVID

Last Name

BAKER

Suffix

Business Name

SAM DAVID BAKER OD

Original Issue Date

05/13/2005

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Ever Disciplined

LastModifiedDate

05/02/2008