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Product Name
Price
Quantity
Subtotal











DIVERSO 2204 M 0005 47-18

Select Lenses:

POLY HMC ( + $32.00 )

Prescription:

RIGHT

SPH:

5

CYL:

5

AXIS:

5

PRISM:

5

PD:

5

left:

LEFT

sph:

5

cyl:

5

axi:

5

prism:

5

pd:

5

Patient Name / Special Instructions:

aaa


$57.00

−+



$57.00










DIVERSO 1411 0046 46-16

Prescription:

RIGHT

left:

LEFT


$25.00

−+



$250.00









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Applicable taxes will be added to the invoice

Subtotal $307.00
Shipping
Total $307.00


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