BRIAN RICHARD BENITZ OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926669

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

RICHARD

Last Name

BENITZ

Suffix

Business Name

BRIAN RICHARD BENITZ OD

Original Issue Date

12/23/1999

Effective Date

08/26/2003

Expiration Date

03/31/2000

City

KEWANEE

State

Zip

61443

County

HENRY

Ever Disciplined

LastModifiedDate

09/11/2005