DENNIS M BRTVA Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929255

License Status

CANCELLED

Business

First Name

DENNIS M

Last Name

BRTVA

Business Name

DENNIS M BRTVA

Original Issue Date

01/29/2003

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

FORSYTH

State

Zip

62535

County

MACON

Ever Disciplined

LastModifiedDate

05/04/2010