KEITH R HAMM OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929076

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

HAMM

Suffix

Business Name

KEITH R HAMM OD

Original Issue Date

10/18/2002

Effective Date

02/11/2004

Expiration Date

03/31/2006

City

STAUNTON

State

Zip

62088

County

MACOUPIN

Ever Disciplined

LastModifiedDate

05/11/2006