LISA ROSE THATCH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****60

License Status

NOT RENEWED

Business

First Name

LISA

Middle

ROSE

Last Name

THATCH

Suffix

Business Name

LISA ROSE THATCH OD

Original Issue Date

03/12/2004

Effective Date

02/14/2012

Expiration Date

03/31/2014

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014