BETHANY MARIE LEWALLEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926127

License Status

NOT RENEWED

Business

First Name

BETHANY

Middle

MARIE

Last Name

LEWALLEN

Suffix

Business Name

BETHANY MARIE LEWALLEN OD

Original Issue Date

02/23/1999

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005