BRUCE S JACOBS Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047205159

License Status

NOT RENEWED

Business

First Name

BRUCE S

Last Name

JACOBS

Business Name

BRUCE S JACOBS

Original Issue Date

05/17/1979

Expiration Date

01/01/1997

City

ROCKFORD

State

Zip

61112

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/01/2005