KATHLEEN A MAES-PUKALA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047930980

License Status

NOT RENEWED

Business

First Name

KATHLEEN

Middle

Last Name

MAES-PUKALA

Suffix

Business Name

KATHLEEN A MAES-PUKALA OD

Original Issue Date

03/10/2005

Effective Date

03/10/2005

Expiration Date

03/31/2006

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006