DENNIS M BRTVA Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047925430

License Status

NOT RENEWED

Business

First Name

DENNIS M

Last Name

BRTVA

Business Name

DENNIS M BRTVA

Original Issue Date

09/11/1997

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Ever Disciplined

LastModifiedDate

09/11/2005