JENNIFER MAY WALLER OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047925859

License Status

CANCELLED

Business

First Name

JENNIFER

Middle

MAY

Last Name

WALLER

Suffix

Business Name

JENNIFER MAY WALLER OD

Original Issue Date

09/09/1998

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

GIRARD

State

Zip

62640

County

MACOUPIN

Ever Disciplined

LastModifiedDate

05/04/2010