55 lines
1.4 KiB
Markdown
55 lines
1.4 KiB
Markdown
---
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type: prescription
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category: eye
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person: Xuewei Jiang
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date: 2021-11-17
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provider: Maylin Gonzalez, OD — Eyed LA Optometry
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source: jiang_LA_2021.pdf
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---
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# Eyeglass Rx — Xuewei Jiang — 11/17/2021
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## Provider
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- **Practice:** Eyed LA Optometry
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- **Doctor:** Maylin Gonzalez, OD
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- **License #:** 14297
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- **Address:** 1150 18th Street suite 103, Santa Monica CA 90403
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- **Phone:** (424) 208-3107
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## Patient Information
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- **Patient:** Xuewei Jiang
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- **DOB:** 03/13/1993
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- **Address:** 11950 Idaho Ave. apt. 113, Los Angeles CA 90025
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## Exam Details
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- **Date:** 11/17/2021
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- **Expires:** 11/17/2023
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- **Rx #:** 168263508
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## Rx Details
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| | Sphere | Cyl | Axis | Near Add | Int Add | H Prism | V Prism |
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|----|--------|-------|------|----------|---------|---------|---------|
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| OD | -3.25 | | | | | | |
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| OS | -3.25 | -0.25 | 098 | | | | |
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- **Distance PD:** 58.0
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## Special Instructions and Recommendations
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| Feature | Value |
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|----------------|---------------|
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| Material | Polycarbonate |
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| Tint | |
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| AR Coating | Yes |
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| Photochromic | |
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| UV Treatment | Yes |
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| Polarized | |
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| LensType | |
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| Instructions | |
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Signed: Maylin Gonzalez, OD
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