WAYNE F PROVINES Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046006017

License Status

NOT RENEWED

Business

First Name

WAYNE F

Last Name

PROVINES

Business Name

WAYNE F PROVINES

Original Issue Date

08/25/1961

Expiration Date

01/01/1997

City

JACKSONVILLE

State

Zip

72076

County

ARIZONA

Ever Disciplined

LastModifiedDate

08/31/2005