BENNETT W NELSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930711

License Status

NOT RENEWED

Business

Title

First Name

BENNETT

Middle

Last Name

NELSON

Business Name

BENNETT W NELSON OD

Original Issue Date

11/05/2004

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

PERU

State

Zip

61354

County

LA SALLE

Ever Disciplined

LastModifiedDate

01/10/2008