BLAIR TANAKA OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935209

License Status

CANCELLED

Business

First Name

BLAIR

Last Name

TANAKA

Suffix

Business Name

BLAIR TANAKA OD

Original Issue Date

04/03/2009

Effective Date

04/03/2009

Expiration Date

03/31/2010

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Ever Disciplined

LastModifiedDate

05/04/2010