THOMAS K BIALECKE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929920

License Status

NOT RENEWED

Business

Title

First Name

THOMAS

Middle

Last Name

BIALECKE

Business Name

THOMAS K BIALECKE OD

Original Issue Date

12/19/2003

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/11/2005