SUSANNA C FOSTIAK Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933689

License Status

CANCELLED

Business

First Name

SUSANNA C

Last Name

FOSTIAK

Business Name

SUSANNA C FOSTIAK

Original Issue Date

01/16/2008

Effective Date

01/16/2008

Expiration Date

03/31/2010

City

NORTHBROOK

State

Zip

60062

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010