MARK COULTER RAFFERTY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930384

License Status

NOT RENEWED

Business

First Name

MARK

Middle

COULTER

Last Name

RAFFERTY

Suffix

Business Name

MARK COULTER RAFFERTY OD

Original Issue Date

06/30/2004

Effective Date

06/30/2004

Expiration Date

03/31/2006

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/11/2006