DONALD MAZZULLA OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****60

License Status

NOT RENEWED

Business

First Name

DONALD

Last Name

MAZZULLA

Suffix

Business Name

DONALD MAZZULLA OD

Original Issue Date

05/22/1996

Expiration Date

03/31/1998

City

CHICAGO HEIGHTS

State

Zip

60411

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006