TRAVIS S PARK 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

TRAVIS

Middle

Last Name

PARK

Suffix

Business Name

TRAVIS S PARK OD

Original Issue Date

04/08/2009

Effective Date

02/21/2014

Expiration Date

03/31/2016

City

CHICAGO

State

Zip

60622

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016