DONALD MAZZULLA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047925255

License Status

NOT RENEWED

Business

First Name

DONALD

Last Name

MAZZULLA

Suffix

Business Name

DONALD MAZZULLA OD

Original Issue Date

03/13/1997

Effective Date

06/12/1999

Expiration Date

03/31/1998

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/01/2005