MARIAM ETHEZAZ OD Optometrist License verification

Business Entity

ACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****88

License Status

ACTIVE

Business

Title

First Name

MARIAM

Last Name

ETHEZAZ

Business Name

MARIAM ETHEZAZ OD

Original Issue Date

08/13/2018

Effective Date

03/20/2024

Expiration Date

03/31/2026

City

CHICAGO

State

Zip

60625

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/08/2026