KEITH R HAMM OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935679

License Status

CANCELLED

Business

First Name

KEITH

Middle

Last Name

HAMM

Suffix

Business Name

KEITH R HAMM OD

Original Issue Date

09/11/2009

Effective Date

09/11/2009

Expiration Date

03/31/2010

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Ever Disciplined

LastModifiedDate

05/04/2010