MIRIAM M WELLER Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****43

License Status

NOT RENEWED

Business

First Name

MIRIAM

Middle

Last Name

WELLER

Business Name

MIRIAM M WELLER

Original Issue Date

04/07/1997

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

MOUNT PROSPECT

State

Zip

60056

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/02/2008