JONATHAN D GOULART OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047017745

License Status

CANCELLED

Business

First Name

JONATHAN

Middle

Last Name

GOULART

Suffix

Business Name

JONATHAN D GOULART OD

Original Issue Date

09/29/1995

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

OREGON

State

Zip

61061

County

OGLE

Ever Disciplined

LastModifiedDate

05/04/2010