TRACEY LYNN PETHOUD OD - Optometrist License in Illinois | # 047932778

TRACEY LYNN PETHOUD OD

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047932778

License Status

CANCELLED

Business

N

First Name

TRACEY

Middle

LYNN

Last Name

PETHOUD

Suffix

OD

Business Name

TRACEY LYNN PETHOUD OD

Original Issue Date

01/12/2007

Effective Date

01/10/2008

Expiration Date

03/31/2010

State

IL

Ever Disciplined

N

LastModifiedDate

05/04/2010