ELLEN RENEE PETROCZKY Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047934103

License Status

CANCELLED

Business

First Name

ELLEN

Middle

RENEE

Last Name

PETROCZKY

Business Name

ELLEN RENEE PETROCZKY

Original Issue Date

04/11/2008

Effective Date

04/11/2008

Expiration Date

03/31/2010

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010