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Contact Lens
Order Form

New Service Offering!

The Salzano Eye Center is excited to offer this new service where you can order your new Contact Lens

prescription directly from our website!  We hope you will like the convenience ordering your contact lenses right from your home. 

Please provide the following information:

Please fill out the order form below and click submit to send your order.   *(OU stands for both eyes)

Patient Information

Contact Lens Information

Please add second brand below.

Prescription Information

If different brand per eye, please indicate which brand for which eye.

1-973-226-0559
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Monday:        9:00am - 6:00pm

Tuesday:        9:00am - 5:00pm

Wednesday:  9:00am - 5:00pm

Thursday:      9:00am - 5:00pm

Friday:            9:00am - 3:00pm

© Salzano Eye Center 2025   All Rights Reserved

Salzano Eye Center

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