Register

If you already have an account with us, please login at the login page.

Please enter the information below.

your personal details

Title

First Name *

Last Name *

Former Last Name

Email Address *

Cell Phone

Home Phone *

Office Phone

Fax

Date of Birth *

For identification purposes only

your address

Street Addr 1 *

Street Addr 2

PO Box

City *

Country

State *

Zip Code *

Selected Practice Location

Location State

Location *

Password

Password *

Password must meet the following requirements:

At least one letter
At least one capital letter
At least one number
Be at least 8 characters

Confirm Password *

How did you hear about our online store?

Employee Information

Name of Employee

Relation to Employee

Are you a patient of our practice?

Required for contact lens verification.

Your Doctor

Your Optical Practice's Contact Information

Required for contact lens verification.

Practice name

Practice Phone

Practice Fax

By clicking REGISTER you agree to our Terms of Service and that we comply with all HIPAA regulations regarding your privacy. Our HIPAA Statement is available to you at any time under the Privacy Statement tab in our webstore. You may opt out of any emails you receive from our online store at any time.