GRANT Y FUSATO OD Optometrist License verification

Business Entity

INOPERATIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****62

License Status

INOPERATIVE

Business

First Name

GRANT

Middle

Last Name

FUSATO

Suffix

Business Name

GRANT Y FUSATO OD

Original Issue Date

10/24/1997

Effective Date

08/04/1999

Expiration Date

03/31/2000

City

NORTH RIVERSIDE

State

Zip

60546

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005