Home Page
|
Search
|
Order Contact Lenses
|
Links
We provide you with two alternatives for ordering replacement contact lenses.
Either fill in the online form, below, or
log into our online ordering system
.
Name
Your Email
Street Address
City, State
Zip Code
Daytime Phone
Insurance
None
AETNA US HEALTH CARE
BC/BS - Gateway
BC/BS- Optichoice
BC/BS - Optichoice Gold
BC/BS - Penn Vision
DAVIS VISION
Eyemed
FIRST HEALTH
MEDICARE
NORTH AMERICAN
NVA
OPTIVISION/NVA
TPA- SUSQUEHANNA SCHOOL DISTRICT
VBA- VISION BENEFITS OF AMERICA
OTHER (Please call our office)
Insurance Number
Quantity of lenses desired
Please select from the list below
One box per eye
Two boxes per eye
Three boxes per eye
Four boxes per eye
If you are ordering your next supply of
disposable contact lenses
, you may skip the rest of the questions and submit the form.
Type of contact lens needed:
Soft
Gas Permeable
Which eye/eyes require lens replacement?
Left
Right
Both Eyes
How would you like us to notify you of your order status?
Telephone
Email
Other information you want us to know:
We
provide you with two alternatives for ordering replacement contact
lenses. Either fill in the online form, below, or