Lincoln Vision Center
651 N 66th
Suite 200
Lincoln, NE 68505

Phone: 402-466-0165

 

Welcome to our contact lens reorder page. Please fill out the following
form to the best of your ability if you wish to have your lenses delivered
to your home, office, or other location. We have posted our prices on
this site so you can know how much you are spending. Once we receive
your order, we will send you a statement. If you are eligible for any additional
discounts or promotions, they will be granted automatically. The standard
rate for delivery is $5.95. Some exceptions may apply.

Our team of dedicated   doctors and staff  is committed to the  preservation
Of sight and vision, by utilizing innovative technology to enhance the quality
Of life for  you and your family.  We will  provide the  highest level of  service
Making your lifetime eye care experience incomparable.



Patient Information

 
Required fields are marked with an *
Patient Name

First  *   

Last  *   

Address *
City *

State *
       Zip Code *
Phone number
Email Address
Confirm Email Address
Shipping Method
Is the Shipping Address the
If Not,
enter Shipping Address below

Address
City
State
       Zip Code
Lens Description (as shown on the package or prescription)

Soft lens
Gas Perm
 
Right Eye (OD)
Left Eye (OS)
Lens Name
Base Curve (BC)
Diameter (Dia)
Power
(sph-cyl-axis-add)
Color
Quantity (packs)
Additional
GP Information
   
Special Request
   
Credit Card Information
 

Card Type *

Name on Card *

Expiration Date (mm/yyyy) *

Card Number *

Security Code * If on your card

Is the Credit Card Billing Address the
same as in Patient Information section?

 
If not,
enter Credit Card Billing Address below

Address *
City *
State *
       Zip Code *
 
Fraud Protection Warning:
Processing of your order may be delayed if the name and address
provided for this credit card do not match the billing address of the card.

This order is subject to the expiration of product and quantity allowed by your prescription.

If you have any questions or experience any problems using this page,
contact our office at 402-466-0165