T DANE SHELLEY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047606644

License Status

NOT RENEWED

Business

First Name

Middle

DANE

Last Name

SHELLEY

Suffix

Business Name

T DANE SHELLEY OD

Original Issue Date

04/18/1995

Expiration Date

03/31/1996

City

BARTONVILLE

State

Zip

61607

County

PEORIA

Ever Disciplined

LastModifiedDate

09/01/2005