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Licensing details for: 9184

Name: Ansevics, Debra Susan

License Type: Registered Contact Lens Dispenser

Primary Status: Current Primary Status Definition

Address of Record

4063 Opal St
JURUPA VALLEY CA 92509-7263
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Issuance Date

December 2, 2024

Expiration Date

December 31, 2026

Current Date / Time

November 5, 2025
2:31:7 PM

License Relationships

RDO to Registered Contact Lens Dispenser

License/Registration Role: Registered Contact Lens Dispenser

Related Party Role: Registered Dispensing Ophthalmic Business

Name: COSTCO WHOLESALE #678

License/Registration Type: Registered Dispensing Ophthalmic Business

License Number: 6856 Primary Status: Current

Address :
11800 4TH STREET
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO COUNTY

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SLD Dispenser & CLD Dispenser

License/Registration Role: Registered Contact Lens Dispenser

Related Party Role: Registered Spectacle Lens Dispenser

Name: Ansevics, Debra Susan

License/Registration Type: Registered Spectacle Lens Dispenser

License Number: 42714 Primary Status: Current

Address :
4063 Opal St
JURUPA VALLEY CA 92509-7263
RIVERSIDE COUNTY

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