STACY ANNE TWENHAFEL OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047935671

License Status

CANCELLED

Business

First Name

STACY

Middle

ANNE

Last Name

TWENHAFEL

Suffix

Business Name

STACY ANNE TWENHAFEL OD

Original Issue Date

09/09/2009

Effective Date

09/09/2009

Expiration Date

03/31/2010

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

05/04/2010