QUENTIN GIN PARK OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935271

License Status

CANCELLED

Business

First Name

QUENTIN

Middle

GIN

Last Name

PARK

Suffix

Business Name

QUENTIN GIN PARK OD

Original Issue Date

04/21/2009

Effective Date

04/21/2009

Expiration Date

03/31/2010

City

SANDWICH

State

Zip

60548

County

DEKALB

Ever Disciplined

LastModifiedDate

05/04/2010