Order Contacts
Fill out this order form so we can evaluate your request. We will call you to confirm your payment method & order requirements. If you have any questions, please give us a call.

Office
Full Name
Date of Birth (mm/dd/yyyy)
Phone (xxx-xxx-xxxx)
Email
Patient Status
Which eye(s) are you ordering contacts for

Vision Insurance Info (Optional)
Enter plan provider and your ID #
(Note: Medicaid does not cover contact lenses)
Notes



2115 S. HACIENDA BLVD.
HACIENDA HEIGHTS, CA 91745
Call (626) 330-4115
Map it!
Mon
9:00 - 6:00
Tue
9:00 - 6:00
Wed
9:00 - 6:00
Thu
Closed
Fri
9:00 - 6:00
Sat
9:00 - 5:00
Sun
Closed
500 N. ATLANTIC BLVD. UNIT 151
MONTEREY PARK, CA 91754
Call (626) 458-2020
Map it!
Mon
10:00 - 5:00
Tue
10:00 - 5:00
Wed
10:00 - 5:00
Thu
10:00 - 5:00
Fri
10:00 - 5:00
Sat
Closed
Sun
Closed
Hacienda Heights Office 21115 S. Hacienda BLVD Hacienda Heights, CA 91745 Phone:
Monterey Park Office 500 N. Atlantic Blvd. Unit 151 Monterey Park, CA 91754 Phone:

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