NATHAN JAMES BONILLA-WARFORD 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

NATHAN

Middle

JAMES

Last Name

BONILLA-WARFORD

Suffix

Business Name

NATHAN JAMES BONILLA-WARFORD OD

Original Issue Date

06/22/2004

Effective Date

07/23/2004

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006