VASANA LERDVORATAVEE OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047933799

License Status

CANCELLED

Business

First Name

VASANA

Last Name

LERDVORATAVEE

Suffix

Business Name

VASANA LERDVORATAVEE OD

Original Issue Date

02/27/2008

Effective Date

02/27/2008

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/04/2010