HEATHER MARIE COCKLAN Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****06

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

MARIE

Last Name

COCKLAN

Business Name

HEATHER MARIE COCKLAN

Original Issue Date

09/24/2003

Effective Date

02/10/2004

Expiration Date

03/31/2006

City

ROCKFORD

State

Zip

61112

County

WINNEBAGO

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006