TERESA BETH EIDE 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

TERESA

Middle

BETH

Last Name

EIDE

Business Name

TERESA BETH EIDE

Original Issue Date

12/19/2007

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

BROADVIEW

State

Zip

60155

County

COOK

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010