TINA RENAE PORZUKOWIAK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****05

License Status

NOT RENEWED

Business

First Name

TINA

Middle

RENAE

Last Name

PORZUKOWIAK

Suffix

Business Name

TINA RENAE PORZUKOWIAK OD

Original Issue Date

07/11/2006

Effective Date

07/11/2006

Expiration Date

03/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/02/2008