Zenni FSA receipt
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Zenni Optical Online Order Receipt 448 Ignacio Blvd #332 Novato, CA 94949 United States Support: (800) 555-9201
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Thank you for your purchase at Zenni Optical! FSA Eligible Eyewear Purchase Receipt
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Customer
Jason Miller
Order #
ZN-784593
Email
Prescription Type
Single Vision
Patient Name
Jason Miller
Prescribing Doctor
Dr. Emily Ross
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Order Date: 10/05/2026
Order Time: 1:12 PM
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1
Prescription Eyeglasses Frame
$29.95
1
Single Vision Lenses
$19.95
1
Anti-Reflective Coating
$12.95
1
Blue Light Blocking Filter
$9.95
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Subtotal$72.80
Tax (6.5%)$3.68
합계
$76.48
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Payment MethodFSA Card
Card Last 46214
Entry MethodOnline Payment
Authorization Code593821
StatusApproved
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1234567890
This receipt may be used for FSA reimbursement. Please retain for your records. Visit www.zennioptical.com for support.
