SHAIROZ A FAZAL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****81

License Status

NOT RENEWED

Business

First Name

SHAIROZ

Middle

Last Name

FAZAL

Suffix

Business Name

SHAIROZ A FAZAL OD

Original Issue Date

11/19/1996

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

LOMBARD

State

Zip

60148

County

DUPAGE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/02/2008