STACY ANNE TWENHAFEL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930703

License Status

NOT RENEWED

Business

First Name

STACY

Middle

ANNE

Last Name

TWENHAFEL

Suffix

Business Name

STACY ANNE TWENHAFEL OD

Original Issue Date

10/29/2004

Effective Date

10/29/2004

Expiration Date

03/31/2006

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

05/11/2006