SHAYMA R ANSARI OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****34

License Status

CANCELLED

Business

First Name

SHAYMA

Middle

Last Name

ANSARI

Suffix

Business Name

SHAYMA R ANSARI OD

Original Issue Date

11/06/2003

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

NILES

State

Zip

60714

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006