KEITH KOWALSKE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047017882

License Status

NOT RENEWED

Business

First Name

KEITH

Last Name

KOWALSKE

Suffix

Business Name

KEITH KOWALSKE OD

Original Issue Date

04/06/1996

Effective Date

06/12/1999

Expiration Date

03/31/1998

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

09/01/2005