STEPHANIE ROBERTA JOHNSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047207055

License Status

NOT RENEWED

Business

First Name

STEPHANIE

Middle

ROBERTA

Last Name

JOHNSON

Suffix

Business Name

STEPHANIE ROBERTA JOHNSON OD

Original Issue Date

03/09/1991

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

CHICAGO

State

Zip

60621

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005