QUENTIN GIN PARK OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047934342

License Status

CANCELLED

Business

First Name

QUENTIN

Middle

GIN

Last Name

PARK

Suffix

Business Name

QUENTIN GIN PARK OD

Original Issue Date

06/28/2008

Effective Date

06/28/2008

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/04/2010