DAVID A NIELSEN Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047928963

License Status

NOT RENEWED

Business

First Name

DAVID A

Last Name

NIELSEN

Business Name

DAVID A NIELSEN

Original Issue Date

09/10/2002

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/11/2005