California State Board of Optometry

License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: NORTHCUTT, TYRELL JAMES

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5643 Primary Status: Cancelled

Address :
1800 S. JUNIPER ST
ESCONDIDO CA 92025
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: HASEGAWA, SHIMON

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5829 Primary Status: Revoked

Address :
719 S TWIN OAKS VALLEY RD #566
SAN MARCOS CA 92078
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: HUYNH, AMY HSU

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5110 Primary Status: Cancelled

Address :
15293 MATURIN DR # 92
SAN DIEGO CA 92127
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: GRIEB, BOB

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 4606 Primary Status: Cancelled

Address :
PO BOX 1881
ESCONDIDO CA 92033
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: RODRIGUEZ, TAMMY LEE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5295 Primary Status: Current

Address :
9619 Gold Coast Dr Apt G6
SAN DIEGO CA 92126-3982
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Becker, Jennifer Murray

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 41930 Primary Status: Current

Address :
1469 Carpinteria St
CHULA VISTA CA 91913-2521
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Cervantes, Elvia M

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 43657 Primary Status: Current

Address :
1284 Auto Park Way Ste C
ESCONDIDO CA 92029-2222
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: CRUZ, PEDRO

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5750 Primary Status: Current

Address :
31405 Corderro Ln
MENIFEE CA 92584-7440
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Dewald, Jeff

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 41955 Primary Status: Current

Address :
3202 E Vista Way
VISTA CA 92084-1533

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Salinas, Lorena

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 43641 Primary Status: Current

Address :
1432 Langford St
OCEANSIDE CA 92058-2216
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: HO, VAN T

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5067 Primary Status: Cancelled

Address :
1503 W BORDEN ROAD
SAN MARCOS CA 92069
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: GONZALEZ, CESAR M

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5024 Primary Status: Cancelled

Address :
2130 PEPPER TREE PLACE
ESCONDIDO CA 92026
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Damico, Nicole Christine

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 42090 Primary Status: Current

Address :
1284 Auto Park Way
Unit C
ESCONDIDO CA 92029-2222
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: GARCIA, RAFAEL CARLOS

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5630 Primary Status: Cancelled

Address :
475 BEAUMONT GLEN # 231
ESCONDIDO CA 92026
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: NEALY, NIKKI KEOSHA

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5998 Primary Status: Cancelled

Address :
801 HILLSIDE TERRACE #43
VISTA CA 92084
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: MUNSEY III, CECIL R

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5756 Primary Status: Cancelled

Address :
1765 Troy Ln
OCEANSIDE CA 92054-5648
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Price, Roger Taylor

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 42757 Primary Status: Current

Address :
3513 Cockatoo Ct
OCEANSIDE CA 92057-1952

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: EDWARDS, SARAH MICHELE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 43263 Primary Status: Current

Address :
1917 Encino Dr
ESCONDIDO CA 92025-6719
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: DOYLE, KEVIN RONALD

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 6011 Primary Status: Cancelled

Address :
10678 VISTA VALLE DRIVE
SAN DIEGO CA 92131
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Truong, Andrew Tien

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 41898 Primary Status: Current

Address :
4707 Lofty Grove Dr
OCEANSIDE CA 92056-3572

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Optometrist

Name: RICH, ASHLEE ELIZABETH

License/Registration Type: Optometrist

License Number: 15052 Primary Status: Current

Address :
1284 Auto Park Way Ste C
ESCONDIDO CA 92029-2222
SAN DIEGO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Optometrist

Name: Mashiana, Amanjot

License/Registration Type: Optometrist

License Number: 34054 Primary Status: Current

Address :
1284 Auto Park Way
Ste C
ESCONDIDO CA 92029-2222
SAN DIEGO COUNTY

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