California State Board of Optometry

License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Gallegos, Jennifer

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 43427 Primary Status: Current

Address :
1112 S Riverside Ave
RIALTO CA 92376-7504

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Corona, Andrea Lilliana

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 42949 Primary Status: Current

Address :
3625 Polk St
B
RIVERSIDE CA 92505
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: ALANIZ, EDUARDO A

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 40208 Primary Status: Current

Address :
5938 Winncliff Dr
RIVERSIDE CA 92509-5352
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Servin De La Mora, Gladys Marlenne

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 41106 Primary Status: Current

Address :
2869 S Cypress Point Dr
ONTARIO CA 91761-7442
SAN BERNARDINO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: RUIZ, OLIVIA

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5119 Primary Status: Cancelled

Address :
11103 SUNGLOW DRIVE
MORENO VALLEY CA 92557
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: SLUSSER, BRIAN ALLEN

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 6114 Primary Status: Cancelled

Address :
600 CENTRAL AVENUE #192
RIVERSIDE CA 92507
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: GARCIA, ANGEL FELIPE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5181 Primary Status: Current

Address :
34171 PAMPLONA AVE
MURRIETA CA 92563
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: URRUTIA, CHRISTINA MARIE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 40823 Primary Status: Current

Address :
3143 Mammoth Ave
JURUPA VALLEY CA 92509-1471
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Magallanes, Kathy

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 41374 Primary Status: Current

Address :
3701 Fillmore St
Spc 11
RIVERSIDE CA 92505-4841
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: Rivera, John

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 42118 Primary Status: Cancelled

Address :
3681 Ada Ct
RIVERSIDE CA 92505-3613

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: THEPMONTRY-NHEP, CHANSAMONE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 6063 Primary Status: Cancelled

Address :
34338 FOREST OAKS DR
YUCAIPA CA 92399
SAN BERNARDINO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: SZCZUBLEWSKI, ROLEEN RYELMA

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 6870 Primary Status: Delinquent

Address :
4374 9th St
RIVERSIDE CA 92501-3106
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: KAWECKI, JOHN STEVEN

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 4851 Primary Status: Current

Address :
8167 Vineyard Ave Apt 119
RANCHO CUCAMONGA CA 91730-3392
SAN BERNARDINO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: GEMMA, FRANCES MAGALENE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 6613 Primary Status: Cancelled

Address :
11467 64TH STREET
MIRA LOMA CA 91752
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: QUINTANA, MARYANNE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5404 Primary Status: Cancelled

Address :
418 W KENDALL ST
CORONA CA 92882
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: VALENCIA, STEPHANIE ANN

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5340 Primary Status: Current

Address :
866 S Rexford St
RIALTO CA 92376-7247
SAN BERNARDINO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: FALCONE, NICHOLAS JAMES

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 40920 Primary Status: Current

Address :
3066 Edwards Pl
RIVERSIDE CA 92503-5819
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: CUNNINGHAM, WILLIAM ANDREW III

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 40916 Primary Status: Cancelled

Address :
3572 Banbury Dr Apt 93
RIVERSIDE CA 92505-1925
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: SANTAMARIA, LUIS ARMANDO

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 4694 Primary Status: Cancelled

Address :
40820 WINCHESTER ROAD #1360
TEMECULA CA 92591
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: AYERS, MICHELLE KRISTINE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5740 Primary Status: Cancelled

Address :
8241 VERBENA DRIVE
RIVERSIDE CA 92504
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: JONES, CYNTHIA MARIE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 4841 Primary Status: Cancelled

Address :
12513 EISENHOWER CT
CHINO CA 91710
SAN BERNARDINO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: MATRONE, MYRA LEE

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 6404 Primary Status: Cancelled

Address :
23442 Woodlander Way
MORENO VALLEY CA 92557-6113
RIVERSIDE COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: WALLACE, AUSTIN DAVID

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 5200 Primary Status: Cancelled

Address :
2901 E Black Horse Dr
ONTARIO CA 91761-9111
SAN BERNARDINO COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Registered Spectacle Lens Dispenser

Name: HAN, RYAN S

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 40340 Primary Status: Cancelled

Address :
809 Excelso Ct
FREMONT CA 94539-6238
ALAMEDA COUNTY

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License/Registration Role: Registered Dispensing Ophthalmic Business

Related Party Role: Optometrist

Name: CAMACHO, ORLANDO

License/Registration Type: Optometrist

License Number: 9161 Primary Status: Current

Address :
2051 Galleria At Tyler
RIVERSIDE CA 92503-4143
RIVERSIDE COUNTY

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