BRENT C NIELSEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926822

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

NIELSEN

Suffix

Business Name

BRENT C NIELSEN OD

Original Issue Date

03/03/2000

Effective Date

11/23/2005

Expiration Date

03/31/2006

City

MCCHESNEY PARK

State

Zip

61115

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/11/2006