DAVID A NIELSEN Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****55

License Status

NOT RENEWED

Business

First Name

DAVID A

Last Name

NIELSEN

Business Name

DAVID A NIELSEN

Original Issue Date

06/17/1997

Effective Date

03/24/2014

Expiration Date

03/31/2016

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/20/2016