SCOTT PAUL BLOMBERG OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929526

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

PAUL

Last Name

BLOMBERG

Suffix

Business Name

SCOTT PAUL BLOMBERG OD

Original Issue Date

08/01/2003

Effective Date

02/04/2004

Expiration Date

03/31/2006

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

05/11/2006