TED KIYOTOSHI NISHIMURA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****30

License Status

NOT RENEWED

Business

First Name

TED

Middle

KIYOTOSHI

Last Name

NISHIMURA

Suffix

Business Name

TED KIYOTOSHI NISHIMURA OD

Original Issue Date

04/03/1997

Effective Date

01/12/2000

Expiration Date

03/31/1998

City

BOLINGBROOK

State

Zip

60440

County

WILL

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/02/2005