JENNIFER LYNN SHANE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****51

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

LYNN

Last Name

SHANE

Suffix

Business Name

JENNIFER LYNN SHANE OD

Original Issue Date

08/11/1999

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005