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Visionary Optics

Uniquely Specialized Contact Lenses

Scleral Lenses
- - Latitude
    - - A freeform scleral lens offering complete contouring to the eye with no limitations.
        
        Learn More
    - - View the guide
  - Europa
    - - A 2nd generation scleral lens design offering the most advanced customization available.
        
        Learn More
    - - View the guide
  - Jupiter
    - - An original classic scleral lens design that originated at Visionary Optics.
        
        Learn More
  - Elara
    - - A scleral lens designed for the regular cornea to offer hydration, comfort and vision.
        
        Learn More
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Scleral Lenses
- Latitude
- Europa
- Jupiter
- Elara
sMap3D
- sMap3D
- Science of sMap3D
Insights
- Insights
- Industry Resources
About
Contact

New Customer Account Signup

Step 1 of 4

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If you are an existing customer and need to submit updates to your account profile, please click here.
Practice & Personnel Information
Name of Practice*
Does your Account require PO# for orders?
- Yes
- No
Is your Account associated with the Military / Government?
- Yes
- No

Eye Care Practitioner
By law, Visionary Optics can only sell directly to a licensed doctor. We take every precaution before selling our medical devices for our protection and yours.
Name of Practitioner*
Credentials*
- OD
- MD
- DO
NPI/License #*
Email Address*
Email Address Confirm Email Address
Phone Number*
Fax Number
Are you a Recent Graduate?*
Graduated within the last 12 months from an accredited US or Canadian School of Optometry. If yes, please also complete New OD Program
- Yes
- No
Do you have additional Eye Care Practitioners?
Choose the amount of additional practitioners you'd like to add to your account below and then fill out their information.
Eye Care Practitioner 2
Name of Practitioner*
Credentials*
- OD
- MD
- DO
NPI/License #*
Email Address*
Email Address Confirm Email Address
Phone Number*
Fax Number
Are you a Recent Graduate?*
Graduated within the last 12 months from an accredited US or Canadian School of Optometry. If yes, please also complete New OD Program
- Yes
- No
Eye Care Practitioner 3
Name of Practitioner*
Credentials*
- OD
- MD
- DO
NPI/License #*
Email Address*
Email Address Confirm Email Address
Phone Number*
Fax Number
Are you a Recent Graduate?*
Graduated within the last 12 months from an accredited US or Canadian School of Optometry. If yes, please also complete New OD Program
- Yes
- No
Eye Care Practitioner 4
Name of Practitioner*
Credentials*
- OD
- MD
- DO
NPI/License #*
Email Address*
Email Address Confirm Email Address
Phone Number*
Fax Number
Are you a Recent Graduate?*
Graduated within the last 12 months from an accredited US or Canadian School of Optometry. If yes, please also complete New OD Program
- Yes
- No
Additional User Information [optional]
This section can include information on other personnel; this could include office manager, technician, etc.
Name
First Last
Email Address
Email Address Confirm Email Address
Phone Number
Fax Number
Do you have additional Users to add?
Choose the amount of additional users you'd like to add to your account below and then fill out their information.
Additional User 2 Information
Name
First Last
Email Address
Email Address Confirm Email Address
Phone Number
Fax Number
Additional User 3 Information
Name
First Last
Email Address
Email Address Confirm Email Address
Phone Number
Fax Number
Additional User 4 Information
Name
First Last
Email Address
Email Address Confirm Email Address
Phone Number
Fax Number

Shipping Information
You will be able to add alternate shipping addresses once your new account has been created.
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Shipping Default Method*
We use UPS as our primary shipping carrier. For International shipments, contact our Customer Service Department for Shipping Options
- Ground
- 3rd Day
- 2nd Day
- Overnight
- Other
Alternate Shipping Email Address [optional]
Shipping notifications can be sent to this alternate address, when applicable.
Email Address Confirm Email Address

Billing Information
Is your Billing Address same as your Shipping Address?*
- Yes
- No
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Enroll in Paperless Statements?*
If Yes, all monthly statements will be emailed to the Billing Email Address.
- Yes
- No
Enroll in Auto Monthly Credit Card Payment?*
If Yes, we will contact you with more details and to complete an Authorization Form.
- Yes
- No
Billing Email Address*
We will send all Billing-related correspondence to this email address.
Enter Email Confirm Email Address
Stay in Touch
How did you find out about us?*
- Colleague Referral
- Industry Meeting
- Workshop
- Email/Internet Search
- Other
Referral Name*
First Last
Referral Email*
Meeting Name*
Workshop Location*
Other Details*
Send me the latest news from Visionary Optics*
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

Have a question?

We’re available M - F, 9 a.m. – 6 p.m. EST.
Phone: 877.533.1509
Email: service@visionary-optics.com

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