NICOLE ANN BLOOMQUIST OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047927509

License Status

CANCELLED

Business

First Name

NICOLE

Middle

ANN

Last Name

BLOOMQUIST

Suffix

Business Name

NICOLE ANN BLOOMQUIST OD

Original Issue Date

10/17/2000

Effective Date

03/01/2002

Expiration Date

03/31/2002

City

GURNEE

State

Zip

60031

County

LAKE

Ever Disciplined

LastModifiedDate

09/01/2005