TARA NICOLE VAN DE WYNGAERDE OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933638

License Status

CANCELLED

Business

First Name

TARA

Middle

NICOLE

Last Name

VAN DE WYNGAERDE

Suffix

Business Name

TARA NICOLE VAN DE WYNGAERDE OD

Original Issue Date

12/18/2007

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

MENDOTA

State

Zip

61342

County

LA SALLE

Ever Disciplined

LastModifiedDate

05/04/2010