THOMAS E THEOBALD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****57

License Status

NOT RENEWED

Business

First Name

THOMAS E

Last Name

THEOBALD

Business Name

THOMAS E THEOBALD

Original Issue Date

05/22/1996

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005