SCOTT PAUL BLOMBERG OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047932658

License Status

CANCELLED

Business

First Name

SCOTT

Middle

PAUL

Last Name

BLOMBERG

Suffix

Business Name

SCOTT PAUL BLOMBERG OD

Original Issue Date

11/15/2006

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/04/2010