California State Board of Optometry

Licensing details for: 40394

Name: MILLER, KEITH ALAN

License Type: Registered Spectacle Lens Dispenser

Primary Status: Cancelled Primary Status Definition

Address of Record

2230 Lake Park Dr Spc 240
SAN JACINTO CA 92583-7640
RIVERSIDE county
Map

Issuance Date

July 8, 2015

Expiration Date

August 31, 2016

Current Date / Time

November 6, 2025
7:36:37 AM

License/Registration Role: Registered Spectacle Lens Dispenser

Related Party Role: Registered Dispensing Ophthalmic Business

Name: NATIONAL VISION EYECARE CENTER #1805

License/Registration Type: Registered Dispensing Ophthalmic Business

License Number: 5738 Primary Status: Cancelled

Address :
79295 HIGHWAY 111
LA QUINTA CA 92253-2060
RIVERSIDE COUNTY