KEITH R HAMM OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929249

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

HAMM

Suffix

Business Name

KEITH R HAMM OD

Original Issue Date

01/29/2003

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

GLEN CARBON

State

Zip

62034

County

MADISON

Ever Disciplined

LastModifiedDate

09/11/2005