POONAM S PATEL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****45

License Status

NOT RENEWED

Business

First Name

POONAM

Middle

Last Name

PATEL

Suffix

Business Name

POONAM S PATEL OD

Original Issue Date

07/29/2011

Effective Date

07/29/2011

Expiration Date

03/31/2012

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/16/2012