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2313 W. Parker Rd. | Plano, Texas 75023 | Phone: 972.612.2015
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Order Contact Lens

To order your contact lens please fill out the following form.

Patient Name:
Address:
City:
State:
Zip:
Day Phone:
Evening Phone:
Date of Birth:
Email Address:
Best way to contact:
Best time to contact:
Number of boxes for right eye:
Number of boxes for left eye:
Comments or Special Instruction:
 


 

 

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