TIM A BENGTSON Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047047904

License Status

NOT RENEWED

Business

First Name

TIM A

Last Name

BENGTSON

Business Name

TIM A BENGTSON

Original Issue Date

11/16/1994

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

ASTORIA

State

Zip

61501

County

FULTON

Ever Disciplined

LastModifiedDate

09/11/2005