DAVID JOHN ANDERSON OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935876

License Status

CANCELLED

Business

First Name

DAVID

Middle

JOHN

Last Name

ANDERSON

Suffix

Business Name

DAVID JOHN ANDERSON OD

Original Issue Date

11/24/2009

Effective Date

11/24/2009

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/04/2010