JEREMY A BEATTY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930659

License Status

NOT RENEWED

Business

First Name

JEREMY

Middle

Last Name

BEATTY

Suffix

Business Name

JEREMY A BEATTY OD

Original Issue Date

10/06/2004

Effective Date

10/06/2004

Expiration Date

03/31/2006

City

WOOD RIVER

State

Zip

62095

County

MADISON

Ever Disciplined

LastModifiedDate

05/11/2006