NATHAN ALAN CROUCH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930857

License Status

NOT RENEWED

Business

Title

First Name

NATHAN

Middle

ALAN

Last Name

CROUCH

Business Name

NATHAN ALAN CROUCH OD

Original Issue Date

01/14/2005

Effective Date

01/14/2005

Expiration Date

03/31/2006

City

KEWANEE

State

Zip

61443

County

HENRY

Ever Disciplined

LastModifiedDate

05/11/2006