J ROBERT FULTS OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047406841

License Status

NOT RENEWED

Business

First Name

Middle

ROBERT

Last Name

FULTS

Suffix

Business Name

J ROBERT FULTS OD

Original Issue Date

09/04/1979

Expiration Date

01/01/1997

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/01/2005