PAY


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



Office Hours
Mon
9:00 - 5:00
Tue
10:00 - 7:00
Wed
9:00 - 6:00
Thu
9:00 - 5:00
Fri
9:00 - 6:00
Sat
Closed
Sun
Closed
3833 Bedford Cyn Rd.
Suite C101
Corona, CA 92883

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Call (951) 898-6979

Email Us
Eagle Glen Optometry 3833 Bedford Canyon Rd. Suite C101 Corona, CA 92883 Phone: (951) 898-6979 Fax: (888) 818-4787

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