BRADLEY S BASHAM Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046008806

License Status

INACTIVE

Business

First Name

BRADLEY S

Last Name

BASHAM

Business Name

BRADLEY S BASHAM

Original Issue Date

08/08/1995

Expiration Date

03/31/1996

City

FORT WAYNE

State

Zip

46815

County

INDIANA

Ever Disciplined

LastModifiedDate

08/31/2005