PRAYAG D SHAH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933465

License Status

NOT RENEWED

Business

First Name

PRAYAG

Middle

Last Name

SHAH

Suffix

Business Name

PRAYAG D SHAH OD

Original Issue Date

10/15/2007

Effective Date

10/15/2007

Expiration Date

03/31/2008

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/02/2008