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Located on the corner of Old York Rd and Township Line Rd
Home » Contact Us » Appointment Request Form

Appointment Request Form

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. You may also visit https://www.smilereminder.com/sr/schedule/anon.do?id=5dcc7903e4c00d3d to select a date and time, Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • :
  • Insurance #1- MedicalInsurance #1- VisionInsurance #1- Secondary
    Please provide your Insurance Information to authorize your visit. For plans that require a Referral please contact your PCP to process prior to your visit. NPI 1366491672
  • This field is for validation purposes and should be left unchanged.
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Dear Patients,

Due to the COVID 19 outbreak we are:

1. Reachable by text 215 376 0306

2. Reachable by email. Receptionist@ElkinsParkEye.com

3. Reachable by phone. If you call our office, it includes LVD cellphone for any urgent questions or emergencies.

4. Able to fulfill orders for Contact Lenses

5. Able to dispense glasses by preparing them for secure individual pickup. Adjustments to the glasses will not be made until it is deemed safe to have face-to-face contact.

6. Wishing you well and missing you a lot.