---
type: receipt
category: eye
person: Xuewei Jiang
date: 2025-12-29
provider: Del Rey Optometry Marina Del Rey
source: jiang_eye_exam_receipt_12_2025.HEIC
---

# Eye Exam Receipt — Xuewei Jiang — 12/29/2025

## Store Information

- **Store:** Del Rey Optometry Marina Del Rey 10
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 90252-5618, United States
- **Phone:** 310-823-4595

## Receipt Details

- **Receipt #:** 3010062
- **Date:** 12/29/25 @ 10:10 AM
- **Store:** 29010 | Register: 3
- **Cashier:** Paola 330031
- **Salesperson:** 330031 (Paola)
- **Order For:** Xuewei (Erica) Jiang
- **Sales Order:** 10122841429010

## Line Items

| Item | Qty | Price | Amount |
|------|-----|-------|--------|
| 92015 Refraction (20500001669638) | 1 | 59.00 | 17.90 |
| 4321-INSURANCE DISCOUNT | | | (41.10) |
| Sales Order 10122841429010 [Doctor Service Addon] | | | |
| Optomap (20500001865028) | 1 | 29.00 | 20.00 |
| 4321-INSURANCE DISCOUNT | | | (19.00) |
| Sales Order 10122841429010 [Doctor Service Addon] | | | |
| 92014 Est Comprehensive (20500001982051) | 1 | 159.00 | 71.60 |
| 4321-INSURANCE DISCOUNT | | | (87.40) |
| Sales Order 10122841429010 [Doctor Service] | | | |
| ADD-ON ONLY PACKAGE ARTICLE | | | |

## Totals

| | Amount |
|---|--------|
| Subtotal | 109.50 |
| Tax | 0.00 |
| **Total** | **109.50** |

## Payment

| | Amount |
|---|--------|
| Assignment Vision Care (10122841429010) | 79.50 |
| Visa 7257 | 30.00 |
| Auth #: | |
| Transaction Type: Sale | |
| Entry Method: Keyed | |
| Auth Time: 10:10 AM | |
| **Change** | **0.00** |

## Notes

> Guarantee: Our goal is 100% satisfaction! If you're not completely satisfied with your purchase within the first 30 days, just let us know. We're committed to making it right.

Total Item(s) purchased: 3

*Customer Copy*