BRUCE MICHAEL PORTNOY Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047126563

License Status

CANCELLED

Business

First Name

BRUCE MICHAEL

Last Name

PORTNOY

Business Name

BRUCE MICHAEL PORTNOY

Original Issue Date

05/06/1981

Expiration Date

05/01/1982

City

ROCKFORD

State

Zip

61112

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/01/2005