KEITH A LA VALLEE OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933163

License Status

CANCELLED

Business

First Name

KEITH

Middle

Last Name

LA VALLEE

Suffix

Business Name

KEITH A LA VALLEE OD

Original Issue Date

07/16/2007

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

CHICAGO

State

Zip

60660

County

COOK

Ever Disciplined

LastModifiedDate

05/04/2010