TRAVIS S PARK OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935191

License Status

CANCELLED

Business

First Name

TRAVIS

Middle

Last Name

PARK

Suffix

Business Name

TRAVIS S PARK OD

Original Issue Date

03/27/2009

Effective Date

03/27/2009

Expiration Date

03/31/2010

City

CHICAGO

State

Zip

60619

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010