TINA MARIE BRANDONISIO OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****39

License Status

NOT RENEWED

Business

First Name

TINA

Middle

MARIE

Last Name

BRANDONISIO

Suffix

Business Name

TINA MARIE BRANDONISIO OD

Original Issue Date

04/04/1997

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/04/2010