MICHAEL E TABERNACKI OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935754

License Status

CANCELLED

Business

First Name

MICHAEL E

Last Name

TABERNACKI

Suffix

Business Name

MICHAEL E TABERNACKI OD

Original Issue Date

10/07/2009

Effective Date

10/07/2009

Expiration Date

03/31/2010

City

CHICAGO

State

Zip

60602

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010