MATTHEW ROGER DE GROOT OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****74

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

ROGER

Last Name

DE GROOT

Suffix

Business Name

MATTHEW ROGER DE GROOT OD

Original Issue Date

06/07/2004

Effective Date

06/07/2004

Expiration Date

03/31/2006

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006