KEITH A LA VALLEE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928646

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

LA VALLEE

Suffix

Business Name

KEITH A LA VALLEE OD

Original Issue Date

04/30/2002

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/11/2005