RICHARD MARK ZAJICEK OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935722

License Status

CANCELLED

Business

Title

First Name

RICHARD MARK

Last Name

ZAJICEK

Business Name

RICHARD MARK ZAJICEK OD

Original Issue Date

09/28/2009

Effective Date

09/28/2009

Expiration Date

03/31/2010

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/04/2010