California State Board of Optometry
Licensing details for: 42136
Name: wijaya, nadine
License Type: Registered Spectacle Lens Dispenser
Primary Status: Cancelled
Address of Record
5101 Hackberry Ln.
apt# 111
SACRAMENTO CA 95841
SACRAMENTO county
Map
License Relationships
RDO to Registered Spectacle Lens Dispenser
License/Registration Role: Registered Spectacle Lens Dispenser
Related Party Role: Registered Dispensing Ophthalmic Business
Name: COSTCO WHOLESALE #771
License/Registration Type: Registered Dispensing Ophthalmic Business
License Number: 6933 Primary Status: Current
Address :
7000 AUBURN BLVD
CITRUS HEIGHTS CA 95621
SACRAMENTO COUNTY
SLD Dispenser & CLD Dispenser
License/Registration Role: Registered Spectacle Lens Dispenser
Related Party Role: Registered Contact Lens Dispenser
Name: wijaya, nadine
License/Registration Type: Registered Contact Lens Dispenser
License Number: 8645 Primary Status: Delinquent
Address :
5101 Hackberry Ln
apt # 111
The Trees at Madison
SACRAMENTO CA 95841-4772
SACRAMENTO COUNTY
