SCOTT B FORD OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047932571

License Status

CANCELLED

Business

First Name

SCOTT

Middle

Last Name

FORD

Suffix

Business Name

SCOTT B FORD OD

Original Issue Date

10/23/2006

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

NILES

State

Zip

60714

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010