MIKI KITAHATA Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****22

License Status

NOT RENEWED

Business

First Name

MIKI

Last Name

KITAHATA

Business Name

MIKI KITAHATA

Original Issue Date

10/21/1996

Effective Date

02/09/2004

Expiration Date

03/31/2006

City

GENEVA

State

Zip

60134

County

KANE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006