DANIEL J MEDEMA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931617

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

Last Name

MEDEMA

Suffix

Business Name

DANIEL J MEDEMA OD

Original Issue Date

11/09/2005

Effective Date

11/09/2005

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006