Patient Number
Secondary Phone
*Box Qty Left Eye 
*Box Qty Right Eye 
Security Code:
Type the Security Code:

Order Contact Lenses

Eye Supply Of Port Jefferson

1092 Route 112, Port Jefferson Station N.Y. 11776
Phone # 631-474-3937
Fax # 631-474-3966
Located in the Uncle Giuseppe's / PJ Cinemas shopping centerĀ 

Please fill out this form to place an order.