MARIAM ETHEZAZ OD Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****31

License Status

INACTIVE

Business

Title

First Name

MARIAM

Last Name

ETHEZAZ

Business Name

MARIAM ETHEZAZ OD

Original Issue Date

12/06/2018

Effective Date

03/10/2020

Expiration Date

03/31/2022

City

CHICAGO

State

Zip

60625

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/10/2020