BLAIR TANAKA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****57

License Status

NOT RENEWED

Business

First Name

BLAIR

Last Name

TANAKA

Suffix

Business Name

BLAIR TANAKA OD

Original Issue Date

10/15/1998

Effective Date

02/26/2014

Expiration Date

03/31/2016

City

DIXON

State

Zip

61021

County

LEE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/20/2016