NICOLE ANN BLOOMQUIST OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****68

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

ANN

Last Name

BLOOMQUIST

Suffix

Business Name

NICOLE ANN BLOOMQUIST OD

Original Issue Date

03/28/2000

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

GURNEE

State

Zip

60031

County

LAKE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005