TIM A BENGTSON Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930163

License Status

CANCELLED

Business

First Name

TIM A

Last Name

BENGTSON

Business Name

TIM A BENGTSON

Original Issue Date

05/26/2004

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Ever Disciplined

LastModifiedDate

05/04/2010