DAISY QIWEN CHAN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****71

License Status

NOT RENEWED

Business

First Name

DAISY

Middle

QIWEN

Last Name

CHAN

Suffix

Business Name

DAISY QIWEN CHAN OD

Original Issue Date

04/08/1997

Effective Date

02/20/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/14/2021