California State Board of Optometry
Licensing details for: 6634
Name: SAM'S CLUB #6613
License Type: Registered Dispensing Ophthalmic Business
Primary Status: Current
Address of Record
7480 CARSON BOULEVARD
LONG BEACH CA 90822
LOS ANGELES county
Map
License Relationships
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: SMITH-TILLETT, ELSA EVERIL
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1417 Primary Status: Cancelled
Address :
1111 E 127TH STREET
LOS ANGELES CA 90059
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: FUENTES, CRYSTAL MARIE
License/Registration Type: Registered Contact Lens Dispenser
License Number: 2230 Primary Status: Cancelled
Address :
2545 Stonegate Dr
RIVERSIDE CA 92506-5027
RIVERSIDE COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: MARTINEZ, DEBRA ANN
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1787 Primary Status: Cancelled
Address :
9508 PIONEER BL
SANTA FE SPRINGS CA 90670
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: ANDRE, SHARON LYNN
License/Registration Type: Registered Contact Lens Dispenser
License Number: 8086 Primary Status: Current
Address :
1527 Redwood Cir
SLIDELL LA 70458-3139
ST. TAMMANY COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: JOHNSON, TRACY JEAN
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1357 Primary Status: Cancelled
Address :
5650 WINDSOR WAY #207
CULVER CITY CA 90230
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: LIEBSACK, MONA RAE
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1392 Primary Status: Cancelled
Address :
4218 W 129TH ST #C
HAWTHORNE CA 90250
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: Abraham, BUSHRA
License/Registration Type: Registered Contact Lens Dispenser
License Number: 8340 Primary Status: Current
Address :
24909 Island Ave
CARSON CA 90745-6547
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: GARCIA, SYLVIA
License/Registration Type: Registered Contact Lens Dispenser
License Number: 2088 Primary Status: Cancelled
Address :
4067 Hardwick St #336
LAKEWOOD CA 90712
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: KEATH, THENG HUY
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1526 Primary Status: Cancelled
Address :
1701 S MARENGO AVE
ALHAMBRA CA 91803
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: OBIETIKPONAH, PRESLEY E
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1524 Primary Status: Cancelled
Address :
4118 W 126TH ST #A
HAWTHORNE CA 90250
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: ARAGON, CESAR A
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1382 Primary Status: Cancelled
Address :
1231 E Elsmere Dr
CARSON CA 90746-2637
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: NEVAREZ, ABIGAIL
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1521 Primary Status: Cancelled
Address :
133 W 91ST STREET
LOS ANGELES CA 90003
LOS ANGELES COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: ROBERTS, WENDY
License/Registration Type: Registered Contact Lens Dispenser
License Number: 1759 Primary Status: Cancelled
Address :
6949 Houston St
#4
BUENA PARK CA 90620-1666
ORANGE COUNTY
RDO to Registered Contact Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Contact Lens Dispenser
Name: Nguyen, Peter Ma
License/Registration Type: Registered Contact Lens Dispenser
License Number: 8359 Primary Status: Cancelled
Address :
7480 Carson Blvd
LONG BEACH CA 90808-2362
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: Nguyen, Peter Ma
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 41028 Primary Status: Delinquent
Address :
7480 Carson Blvd
LONG BEACH CA 90808-2362
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: ANDRE, SHARON LYNN
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 40372 Primary Status: Current
Address :
1527 Redwood Cir
SLIDELL LA 70458-3139
ST. TAMMANY COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: NEVAREZ, ABIGAIL
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 5364 Primary Status: Cancelled
Address :
133 W 91ST STREET
LOS ANGELES CA 90003
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: MANZO, RONY S
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 6556 Primary Status: Revoked
Address :
1729 W 23RD ST
LOS ANGELES CA 90018
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: GARCIA, SYLVIA
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 6382 Primary Status: Cancelled
Address :
4067 Hardwick St #336
LAKEWOOD CA 90712
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: Thelen, Nicole
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 43810 Primary Status: Current
Address :
12772 Longden St
GARDEN GROVE CA 92845-2627
ORANGE COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: Perez, Abran
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 41348 Primary Status: Current
Address :
8515 Borson St
DOWNEY CA 90242-3838
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: LIEBSACK, MONA RAE
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 5098 Primary Status: Cancelled
Address :
4218 W 129TH ST #C
HAWTHORNE CA 90250
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: OBIETIKPONAH, PRESLEY E
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 5367 Primary Status: Cancelled
Address :
4118 W 126TH ST #A
HAWTHORNE CA 90250
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: KEATH, THENG HUY
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 5382 Primary Status: Cancelled
Address :
1701 S MARENGO AVE
ALHAMBRA CA 91803
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: ROSA, LIZZETTE
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 3602 Primary Status: Delinquent
Address :
7119 Kengard Ave
WHITTIER CA 90606
LOS ANGELES COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: VALLEJO, BENJAMIN
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 6458 Primary Status: Current
Address :
2356 W Fruitvale Ave
HEMET CA 92545-1689
RIVERSIDE COUNTY
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Dispensing Ophthalmic Business
Related Party Role: Registered Spectacle Lens Dispenser
Name: FUENTES, CRYSTAL MARIE
License/Registration Type: Registered Spectacle Lens Dispenser
License Number: 6659 Primary Status: Cancelled
Address :
2545 Stonegate Dr
RIVERSIDE CA 92506-5027
RIVERSIDE COUNTY
