LISA ROSE THATCH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****38

License Status

NOT RENEWED

Business

First Name

LISA

Middle

ROSE

Last Name

THATCH

Suffix

Business Name

LISA ROSE THATCH OD

Original Issue Date

03/06/2006

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/04/2010