LISA ROSE THATCH OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930706

License Status

CANCELLED

Business

First Name

LISA

Middle

ROSE

Last Name

THATCH

Suffix

Business Name

LISA ROSE THATCH OD

Original Issue Date

11/05/2004

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

CENTRALIA

State

Zip

62801

County

MARION

Ever Disciplined

LastModifiedDate

05/04/2010