LISA ROSE THATCH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****50

License Status

NOT RENEWED

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

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010