MICHAEL E TABERNACKI OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047932593

License Status

CANCELLED

Business

First Name

MICHAEL E

Last Name

TABERNACKI

Suffix

Business Name

MICHAEL E TABERNACKI OD

Original Issue Date

10/24/2006

Effective Date

10/24/2006

Expiration Date

03/31/2008

City

CHICAGO

State

Zip

60607

County

COOK

Ever Disciplined

LastModifiedDate

01/10/2008