SAM DAVID BAKER OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935377

License Status

CANCELLED

Business

First Name

SAM

Middle

DAVID

Last Name

BAKER

Suffix

Business Name

SAM DAVID BAKER OD

Original Issue Date

06/02/2009

Effective Date

06/02/2009

Expiration Date

03/31/2010

City

DEKALB

State

Zip

60115

County

DEKALB

Ever Disciplined

LastModifiedDate

05/04/2010