SCOTT DALE STAATZ OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****17

License Status

NOT RENEWED

Business

First Name

SCOTT DALE

Last Name

STAATZ

Suffix

Business Name

SCOTT DALE STAATZ OD

Original Issue Date

06/26/1996

Expiration Date

03/31/1998

City

MATTESON

State

Zip

60443

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/02/2005