CHAITALI SHUKLA OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935062

License Status

CANCELLED

Business

First Name

CHAITALI

Last Name

SHUKLA

Suffix

Business Name

CHAITALI SHUKLA OD

Original Issue Date

02/05/2009

Effective Date

02/05/2009

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/04/2010