ANDRIENA FAY ERICKSON OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****34

License Status

CANCELLED

Business

First Name

ANDRIENA

Middle

FAY

Last Name

ERICKSON

Suffix

Business Name

ANDRIENA FAY ERICKSON OD

Original Issue Date

07/19/2002

Effective Date

04/13/2004

Expiration Date

03/31/2004

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005