BRENT C NIELSEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930100

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

NIELSEN

Suffix

Business Name

BRENT C NIELSEN OD

Original Issue Date

04/22/2004

Effective Date

08/08/2006

Expiration Date

03/31/2008

City

EAST PEORIA

State

Zip

61611

County

TAZEWELL

Ever Disciplined

LastModifiedDate

05/02/2008