BENNETT W NELSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933021

License Status

NOT RENEWED

Business

Title

First Name

BENNETT

Middle

Last Name

NELSON

Business Name

BENNETT W NELSON OD

Original Issue Date

05/09/2007

Effective Date

05/09/2007

Expiration Date

03/31/2008

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/10/2008