IEHP Form

Optometrist & Specialty Contact Lenses Professional located in Rancho Cucamonga, CA

understand that IEHP lab can take up to 3 months to return glasses and that Crystal Vision Optometry is not liable for the eyeglass timeframe. I understand that IEHP covers:

Routine eye exam once every 24 months
Eyeglasses (frames and lens) once every 24 months
Single vision lenses/ Bi Focal lenses

Please select

I understand that if IEHP denies a claim for exam or materials, I am responsible for the payment. I understand that Crystal Vision Optometry’s office policy states VERs will not be pulled for any reason. I understand if a redo is requested, a fee will be collected to complete the new order. I understand that IEHP lenses and frames do not come with a warranty. I understand that if materials aren’t deemed medical necessary, I will be responsible payment of any upgrades. I understand, per IEHP Dual Choice handbook, I only have $350 for eyeglass frames or contact lenses and services.

Please do not submit any Protected Health Information (PHI).

Rancho Cucamonga

11940 Foothill Blvd, Suite 103
Rancho Cucamonga, CA 91739

Hours Of Operation:

Monday: 9:00 AM - 5:30 PM
Tuesday: Varies
Wednesday: 9:00 AM - 5:30 PM
Thursday: 9:00 AM - 4:30 PM
Friday: 9:00 AM - 5:30 PM
Saturday: Closed
Sunday: Closed

(909) 980-5552 Book Online

Crystal Vision Optometry

✆ Phone (appointments): (909) 980-5552

Address: 11940 Foothill Blvd, Suite 103, Rancho Cucamonga, CA 91739