NATHAN CURTIS DIECKOW OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935807

License Status

CANCELLED

Business

Title

First Name

NATHAN

Middle

CURTIS

Last Name

DIECKOW

Business Name

NATHAN CURTIS DIECKOW OD

Original Issue Date

10/23/2009

Effective Date

10/23/2009

Expiration Date

03/31/2010

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

05/04/2010