ELILTA BEREKETAB OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930166

License Status

NOT RENEWED

Business

First Name

ELILTA

Last Name

BEREKETAB

Suffix

Business Name

ELILTA BEREKETAB OD

Original Issue Date

05/26/2004

Effective Date

05/26/2004

Expiration Date

03/31/2006

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

05/11/2006