KEITH R HAMM OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931649

License Status

CANCELLED

Business

First Name

KEITH

Middle

Last Name

HAMM

Suffix

Business Name

KEITH R HAMM OD

Original Issue Date

12/21/2005

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

05/04/2010