KELLY KAY KERKSICK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928931

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

KAY

Last Name

KERKSICK

Suffix

Business Name

KELLY KAY KERKSICK OD

Original Issue Date

08/29/2002

Effective Date

06/21/2004

Expiration Date

03/31/2006

City

GLEN CARBON

State

Zip

62034

County

MADISON

Ever Disciplined

LastModifiedDate

05/11/2006