DOUGLAS EDWARD KELLEY OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935197

License Status

CANCELLED

Business

First Name

DOUGLAS

Middle

EDWARD

Last Name

KELLEY

Suffix

Business Name

DOUGLAS EDWARD KELLEY OD

Original Issue Date

03/28/2009

Effective Date

03/28/2009

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61112

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/04/2010