BRENT C NIELSEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926768

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

NIELSEN

Suffix

Business Name

BRENT C NIELSEN OD

Original Issue Date

02/14/2000

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

09/11/2005