LORETTA LYNN DEKOSTER OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****80

License Status

NOT RENEWED

Business

First Name

LORETTA

Middle

LYNN

Last Name

DEKOSTER

Suffix

Business Name

LORETTA LYNN DEKOSTER OD

Original Issue Date

01/03/1997

Effective Date

01/04/2020

Expiration Date

05/31/2022

City

ELMWOOD PARK

State

Zip

60707

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022