REQUEST AN APPOINTMENT Name * First Name Last Name Email * Phone Number * (###) ### #### Reason for Visit * Select Comprehensive Eye Exam Contact Lens Fitting Consultation with Eyewear Specialist DMV Vision Exam Other Date of birth * MM DD YYYY Preferred Date of Visit (Optional) MM DD YYYY Select Your Insurance (Optional) Select 1199 Local Benefit Fund 32BJ Affinity Health Plan Blue Cross Blue Shield CPS optical Davis Vision Fidelis Health First Local 6 Hotel Union Local 237 Local 91 Metro Plus Medicaid Molina Superior Vision United Health Care United Federation of Teachers Welfare Fund (UFT) Union Insurance Vision Screening Don't see my insurance/ other No Insurance How would you like to be contacted? * Email Phone call Text message Message (Optional) Thank you for submitting your appointment request. We appreciate your interest in Eye World Optical. Rest assured, our team will review your request promptly and aim to get back to you within the next 24 hours.
