NICOLE M WILSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****74

License Status

NOT RENEWED

Business

Title

First Name

NICOLE

Middle

Last Name

WILSON

Business Name

NICOLE M WILSON OD

Original Issue Date

07/30/2019

Effective Date

03/16/2020

Expiration Date

05/31/2022

City

HERRIN

State

Zip

62948

County

WILLIAMSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022