KRISTIN LEIGH HAM OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930853

License Status

NOT RENEWED

Business

First Name

KRISTIN

Middle

LEIGH

Last Name

HAM

Suffix

Business Name

KRISTIN LEIGH HAM OD

Original Issue Date

01/14/2005

Effective Date

01/14/2005

Expiration Date

03/31/2006

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

05/11/2006