STEPHANIE ROBERTA JOHNSON OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047007055

License Status

CANCELLED

Business

First Name

STEPHANIE

Middle

ROBERTA

Last Name

JOHNSON

Suffix

Business Name

STEPHANIE ROBERTA JOHNSON OD

Original Issue Date

11/17/1978

Expiration Date

01/01/1997

City

CHICAGO

State

Zip

60616

County

COOK

Ever Disciplined

LastModifiedDate

09/01/2005