TRACEY LYNN PETHOUD OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047932778

License Status

CANCELLED

Business

First Name

TRACEY

Middle

LYNN

Last Name

PETHOUD

Suffix

Business Name

TRACEY LYNN PETHOUD OD

Original Issue Date

01/12/2007

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

WOOD RIVER

State

Zip

62095

County

MADISON

Ever Disciplined

LastModifiedDate

05/04/2010