GRANT Y FUSATO OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047925754

License Status

NOT RENEWED

Business

First Name

GRANT

Middle

Last Name

FUSATO

Suffix

Business Name

GRANT Y FUSATO OD

Original Issue Date

07/16/1998

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

BERWYN

State

Zip

60402

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005