SAM DAVID BAKER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****20

License Status

NOT RENEWED

Business

First Name

SAM

Middle

DAVID

Last Name

BAKER

Suffix

Business Name

SAM DAVID BAKER OD

Original Issue Date

06/30/2005

Effective Date

03/13/2014

Expiration Date

03/31/2016

City

ST CHARLES

State

Zip

60174

County

KANE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016