Contact Information

Please feel free to contact us with any suggestions or concerns you may have.

Phone

(402)-727-9220

Physical Address

Eye Site
1445 North Bell Street
Fremont, NE 68025-3534

Mailing Address

Eye Site
PO Box 72
Fremont, NE 68026-0072

Electronic Mail

Customer Service	customer@eyesiteusa.com
Jill J. Luebbert, Opt., T. R.	jjluebbert@eyesiteusa.com
Dr. C. Dale Bahner	cdbahner@eyesiteusa.com

Or use the form below to send us a comment, ask a question, or
place an order, then click on Submit to send us your information.

Name

Address

City

State

Shipping Address

City

State

E-mail Address

Phone Number for Order Confirmation & Payment

Comment/Questions/Contact Lens Description

Patients requesting a contact lens order, complete and
submit this form stating new order or reorder in box above.
Please include quantity, brand name and price.

Eye Care Professional & Telephone Number

Credit Card Information
Name on card:
Card Number:
Type:		Expiration Date:

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Eye Site^{^®} is registered.
customer@eyesiteusa.com

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