California State Board of Optometry

Licensing details for: 5321

Name: RAPHAEL, SCOTT BRADLEY

License Type: Registered Spectacle Lens Dispenser

Primary Status: Cancelled Primary Status Definition

Previous Names: RAPHAEL, SCOTT B

Address of Record

12750 CENTRALIA ST #118
LAKEWOOD CA 90715
LOS ANGELES county
Map

Issuance Date

August 1, 2005

Expiration Date

April 30, 2007

Current Date / Time

November 6, 2025
4:51:8 AM

License/Registration Role: Registered Spectacle Lens Dispenser

Related Party Role: Registered Dispensing Ophthalmic Business

Name: TARGET OPTICAL SHOP #4256

License/Registration Type: Registered Dispensing Ophthalmic Business

License Number: 6845 Primary Status: Cancelled

Address :
1893 MALVERN AVE
FULLERTON CA 92832
ORANGE COUNTY