NICOLE AMANDA CORSIATTI OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****19

License Status

NOT RENEWED

Business

Title

First Name

NICOLE

Middle

AMANDA

Last Name

CORSIATTI

Business Name

NICOLE AMANDA CORSIATTI OD

Original Issue Date

10/22/2018

Effective Date

10/22/2018

Expiration Date

09/30/2020

City

PLAINFIELD

State

Zip

60586

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021