IVETTA SUE DACCACHE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931217

License Status

NOT RENEWED

Business

First Name

IVETTA

Middle

SUE

Last Name

DACCACHE

Suffix

Business Name

IVETTA SUE DACCACHE OD

Original Issue Date

05/31/2005

Effective Date

05/31/2005

Expiration Date

03/31/2006

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

05/11/2006