GEORGE MICHAEL NISTA OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930565

License Status

CANCELLED

Business

First Name

GEORGE

Middle

MICHAEL

Last Name

NISTA

Suffix

Business Name

GEORGE MICHAEL NISTA OD

Original Issue Date

09/07/2004

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Ever Disciplined

LastModifiedDate

05/04/2010