GARY L BLACKMAN OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047932083

License Status

CANCELLED

Business

First Name

GARY

Middle

Last Name

BLACKMAN

Suffix

Business Name

GARY L BLACKMAN OD

Original Issue Date

04/19/2006

Effective Date

08/18/2009

Expiration Date

03/31/2010

City

PETERSBURG

State

Zip

62675

County

MENARD

Ever Disciplined

LastModifiedDate

05/04/2010