California State Board of Optometry

Licensing details for: 6758

Name: PERERA, SAMANTHA MARIE

License Type: Registered Spectacle Lens Dispenser

Primary Status: Cancelled Primary Status Definition

Address of Record

2 Frontier Rd
POMONA CA 91766-4861
LOS ANGELES county
Map

Issuance Date

March 4, 2013

Expiration Date

April 30, 2016

Current Date / Time

November 6, 2025
4:7:57 AM

License/Registration Role: Registered Spectacle Lens Dispenser

Related Party Role: Registered Dispensing Ophthalmic Business

Name: COSTCO WHOLESALE CORPORATION

License/Registration Type: Registered Dispensing Ophthalmic Business

License Number: 7322 Primary Status: Current

Address :
520 N LONE HILL AVE
SAN DIMAS CA 91773
LOS ANGELES COUNTY