---
type: prescription
category: medical
person: Xuewei Jiang
date: 2021-11-17
provider: Maylin Gonzalez, OD — Eyed LA Optometry
source: jiang_LA_2021.pdf
---

# Eyeglass Rx — Xuewei Jiang — 11/17/2021

## Provider

- **Practice:** Eyed LA Optometry
- **Doctor:** Maylin Gonzalez, OD
- **License #:** 14297
- **Address:** 1150 18th Street suite 103, Santa Monica CA 90403
- **Phone:** (424) 208-3107

## Patient Information

- **Patient:** Xuewei Jiang
- **DOB:** 03/13/1993
- **Address:** 11950 Idaho Ave. apt. 113, Los Angeles CA 90025

## Exam Details

- **Date:** 11/17/2021
- **Expires:** 11/17/2023
- **Rx #:** 168263508

## Rx Details

|    | Sphere | Cyl   | Axis | Near Add | Int Add | H Prism | V Prism |
|----|--------|-------|------|----------|---------|---------|---------|
| OD | -3.25  |       |      |          |         |         |         |
| OS | -3.25  | -0.25 | 098  |          |         |         |         |

- **Distance PD:** 58.0

## Special Instructions and Recommendations

| Feature        | Value         |
|----------------|---------------|
| Material       | Polycarbonate |
| Tint           |               |
| AR Coating     | Yes           |
| Photochromic   |               |
| UV Treatment   | Yes           |
| Polarized      |               |
| LensType       |               |
| Instructions   |               |

Signed: Maylin Gonzalez, OD