THOMAS E THEOBALD Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046006074

License Status

INACTIVE

Business

First Name

THOMAS E

Last Name

THEOBALD

Business Name

THOMAS E THEOBALD

Effective Date

03/28/2002

Expiration Date

03/31/2002

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Ever Disciplined

LastModifiedDate

09/11/2005