type, category, person, date, provider, source
type
category
person
date
provider
source
prescription
medical
Xuewei Jiang
2021-11-17
Maylin Gonzalez, OD — Eyed LA Optometry
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
Special Instructions and Recommendations
Feature
Value
Material
Polycarbonate
Tint
AR Coating
Yes
Photochromic
UV Treatment
Yes
Polarized
LensType
Instructions
Signed: Maylin Gonzalez, OD