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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.
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
Enter Letters/Number you see:



OFFICE HOURS    
Mon
10:00 - 7:00
Tue
10:00 - 7:00
Wed
10:00 - 7:00
Thu
10:00 - 7:00
Fri
10:00 - 7:00
Sat
10:00 - 6:00
Sun
Closed
Designer Optical of Parkchester
1440 Metropolitan Ave.
Bronx, NY 10462
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(347) 281-4441
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Designer Optical of Parkchester 1440 Metropolitan Ave. Bronx, NY 10462 Phone: (347) 281-4441

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