LELAND DAVID PETERSON OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047934404

License Status

CANCELLED

Business

First Name

LELAND

Middle

DAVID

Last Name

PETERSON

Suffix

Business Name

LELAND DAVID PETERSON OD

Original Issue Date

07/16/2008

Effective Date

07/16/2008

Expiration Date

03/31/2010

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

05/04/2010