CHAITALI SHUKLA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****01

License Status

NOT RENEWED

Business

First Name

CHAITALI

Last Name

SHUKLA

Suffix

Business Name

CHAITALI SHUKLA OD

Original Issue Date

08/07/2008

Effective Date

08/07/2008

Expiration Date

03/31/2010

City

SOUTH ELGIN

State

Zip

60177

County

KANE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010