ERIK D BURGWALD OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047008644

License Status

NOT RENEWED

Business

First Name

ERIK D

Last Name

BURGWALD

Suffix

Business Name

ERIK D BURGWALD OD

Original Issue Date

12/16/1994

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

PERU

State

Zip

61354

County

LA SALLE

Ever Disciplined

LastModifiedDate

09/11/2005