BRENT C NIELSEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930182

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

NIELSEN

Suffix

Business Name

BRENT C NIELSEN OD

Original Issue Date

05/26/2004

Effective Date

05/26/2004

Expiration Date

03/31/2006

City

STERLING

State

Zip

61081

County

WHITESIDE

Ever Disciplined

LastModifiedDate

05/11/2006