619 East Lawn Road, Nazareth, PA 18064

☎(610) 759-1635 | ✉Email Us |

Maps

Office Hours

Request Appointment

Patient Intake Forms

Consultation Request
Patient Information
Insurance Information
Dilation Information
Health History

Financial Policy
Consent to Treat Minor
Acknowledgment of Privacy Practice
Authorization to Disclose Health Information
COVID-19 Screening

Order Contacts

Fill out this order form so we can evaluate your request. We will call you to confirm your payment method & order requirements. If you have any questions, please give us a call.

Full Name

Date of Birth (mm/dd/yyyy)

Phone (xxx-xxx-xxxx)

Patient Status

Which eye(s) are you ordering contacts for

Vision Insurance Info (Optional)
Enter plan provider and your ID #
(Note: Medicaid does not cover contact lenses)

Notes

Captcha:

Enter Letters/Number you see:

OFFICE HOURS

Mon

8:30 - 5:00

Tue

8:30 - 5:00

Wed

8:30 - 12:00

Thu

8:30 - 6:30

Fri

8:30 - 5:00

Sat

Call For Hours

Sun

Closed

619 East Lawn Road
Nazareth, PA 18064
Map it!

(610) 759-1635

Nazareth Eye Associates 619 E. Lawn Rd. Nazareth, PA 18064 Phone: (610) 759-1635 Fax: (610) 759-1899

Nazareth Eye Associates proudly serves Nazareth, PA and the surrounding areas of Stockertown, Tatamy, Belfast, Bath, Chapman, Philipsburg, Easton, Bethlehem, Allentown, Bangor and Wind Gap.

Internal email | Internal forms