TIM A BENGTSON Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047057904

License Status

CANCELLED

Business

First Name

TIM A

Last Name

BENGTSON

Business Name

TIM A BENGTSON

Original Issue Date

11/18/1994

Effective Date

04/18/2002

Expiration Date

03/31/2002

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Ever Disciplined

LastModifiedDate

09/01/2005