BRENT C NIELSEN OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931312

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

NIELSEN

Suffix

Business Name

BRENT C NIELSEN OD

Original Issue Date

08/01/2005

Effective Date

08/01/2005

Expiration Date

03/31/2006

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

05/11/2006