GRACE J PAN OD Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****72

License Status

INACTIVE

Business

Title

First Name

GRACE

Middle

Last Name

PAN

Business Name

GRACE J PAN OD

Original Issue Date

06/20/2006

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

NORTHLAKE

State

Zip

60164

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/05/2010