ALEX H KOUKLAKIS OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****90

License Status

NOT RENEWED

Business

First Name

ALEX

Middle

Last Name

KOUKLAKIS

Suffix

Business Name

ALEX H KOUKLAKIS OD

Original Issue Date

12/08/2000

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006