California State Board of Optometry

Licensing details for: 1712

Name: COFFEY, GLENN KEVIN

License Type: Registered Contact Lens Dispenser

Primary Status: Cancelled Primary Status Definition

Address of Record

3278 WANDSWORTH DRIVE
SHASTA LAKE CA 96003
SHASTA county
Map

Issuance Date

May 3, 2007

Expiration Date

January 31, 2019

Current Date / Time

April 8, 2026
4:24:09 AM

License/Registration Role: Registered Contact Lens Dispenser

Related Party Role: Registered Dispensing Ophthalmic Business

Name: COSTCO WHOLESALE CORPORATION

License/Registration Type: Registered Dispensing Ophthalmic Business

License Number: 5729 Primary Status: Cancelled

Address :
1300 DANA DRIVE
REDDING CA 96003
SHASTA COUNTY