GEORGE MICHAEL NISTA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047026886

License Status

NOT RENEWED

Business

First Name

GEORGE

Middle

MICHAEL

Last Name

NISTA

Suffix

Business Name

GEORGE MICHAEL NISTA OD

Original Issue Date

05/09/1992

Expiration Date

03/31/1998

City

ROUND LAKE BEACH

State

Zip

60073

County

LAKE

Ever Disciplined

LastModifiedDate

09/01/2005