MINI JOHN 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

MINI

Last Name

JOHN

Suffix

Business Name

MINI JOHN OD

Original Issue Date

02/01/2002

Effective Date

03/20/2002

Expiration Date

03/31/2004

City

NORRIDGE

State

Zip

60706

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005