T DANE SHELLEY OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935392

License Status

CANCELLED

Business

First Name

Middle

DANE

Last Name

SHELLEY

Suffix

Business Name

T DANE SHELLEY OD

Original Issue Date

06/08/2009

Effective Date

06/08/2009

Expiration Date

03/31/2010

City

PEKIN

State

Zip

61554

County

TAZEWELL

Ever Disciplined

LastModifiedDate

05/04/2010