SAMANTHA RENEE GAGNON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****78

License Status

NOT RENEWED

Business

Title

First Name

SAMANTHA

Middle

RENEE

Last Name

GAGNON

Business Name

SAMANTHA RENEE GAGNON OD

Original Issue Date

06/19/2017

Effective Date

02/22/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021