MARK D REVERE Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047007146

License Status

NOT RENEWED

Business

First Name

MARK D

Last Name

REVERE

Business Name

MARK D REVERE

Original Issue Date

08/02/1979

Expiration Date

01/01/1997

City

MARSEILLES

State

Zip

61341

County

LA SALLE

Ever Disciplined

LastModifiedDate

09/01/2005