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New Eye Care Professional Registration
Account Details
Please provide the following information:
note:
-
fields marked with "
*
" are manditory
-
if you have multiple locations, you will need to register multiple times.
Desired
gotlenses ID:
+
*
Password:
*
Re-enter Password:
*
Practice Name:
*
First Name:
*
Last Name:
*
Street:
*
City:
*
State:
- Select State -
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COL
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
*
Zip:
*
Phone:
*
Fax:
*
E-mail:
*
CooperVision Partner Number:
I have an CooperVision Partner number but do not remember my Partner number
My CooperVision Partner Number is:
Please enter the name or group name to which monthly net payments should be made.
Check Name:
*
State License Number:
*
Designation:
- None Specified -
OD
MD
Contact Method:
E-Mail
Fax
+
This id will be used as your login name when you sign-in to gotlenses.com. Your patients will also be able to access
www.gotlenses.com/
your_gotlensesID
to sign up for their gotlenses.com accounts.
Products to List on gotlenses
Please select which lenses you would like to make available to your patients on your gotlenses site.
Check All
ACUVUE/Johnson & Johnson
Bausch & Lomb
Blanchard Labs
CIBA
Cooper Vision
Cooper Vision/Ocular Sciences
Hydrogel Vision Corporation
LifeStyles
Unilens
As a registered practitioner with gotlenses.com you can determine the retail price for all lenses offered to your patients. gotlenses.com provides the current
competitive retail sell price
. You can select the current competitive online pricing or pricing increments higher or lower. Please make your selection from the list below. If you wish, once your registration is complete you may customize any product from the practitioner maintenance screen.
the same
$ 8.00
$ 7.50
$ 7.00
$ 6.50
$ 6.00
$ 5.50
$ 5.00
$ 4.50
$ 4.00
$ 3.50
$ 3.00
$ 2.50
$ 2.00
$ 1.50
$ 1.00
$ 0.50
$ 0.00
$ -0.50
$ -1.00
$ -1.50
$ -2.00
$ -2.50
$ -3.00
$ -3.50
$ -4.00
$ -4.50
$ -5.00
$ -5.50
$ -6.00
$ -6.50
$ -7.00
$ -7.50
$ -8.00
I have read and accepted the
terms and conditions
.
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