NATHAN CURTIS DIECKOW OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935763

License Status

CANCELLED

Business

Title

First Name

NATHAN

Middle

CURTIS

Last Name

DIECKOW

Business Name

NATHAN CURTIS DIECKOW OD

Original Issue Date

10/09/2009

Effective Date

10/09/2009

Expiration Date

03/31/2010

City

TAYLORVILLE

State

Zip

62568

County

CHRISTIAN

Ever Disciplined

LastModifiedDate

05/04/2010