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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Prescription Type
Single Vision
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
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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.
