JIRASAN SAKULSOM Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****08

License Status

NOT RENEWED

Business

First Name

JIRASAN

Last Name

SAKULSOM

Business Name

JIRASAN SAKULSOM

Original Issue Date

03/27/2012

Effective Date

03/27/2012

Expiration Date

03/31/2014

City

CICERO

State

Zip

60804

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014