THADDEUS S DEPUKAT 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

THADDEUS S

Last Name

DEPUKAT

Business Name

THADDEUS S DEPUKAT

Original Issue Date

12/02/1996

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/02/2008