EMILY ROSE KONCZAL OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047934831

License Status

CANCELLED

Business

First Name

EMILY

Middle

ROSE

Last Name

KONCZAL

Suffix

Business Name

EMILY ROSE KONCZAL OD

Original Issue Date

11/06/2008

Effective Date

11/06/2008

Expiration Date

03/31/2010

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010