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    Scan 26 Sep 2022

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    7 views1 page

    Scan 26 Sep 2022

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    PRO

    Practice No: 0022659

    74 African Street PETER ROEDIGEER


    The Gardens Peter Roediger
    Dip.Optom (SA) CAS (USA) OPTOMETRIST
    Johannesburg HPCSA OP 0016667
    2192 GOC (UK) 01-23966 Tel: 011 728 3689
    Fax: 086 768 0983
    Bank Details: STD
    Bank, Branch: Norwood, Branch Code:
    Email: pro74african@gmail.com

    004105, Acct No: 001854941, Type: Current ount


    MS A SAMO
    410 FRANKLIN ST
    INVOICENo: 7694
    VLACKFONTEIN Own Invoice No: 1
    Account No. 4289
    1829 Medical Aid
    Med.Aid No.
    Tel. (W)
    Tel. (H):
    Employer: ASUREIA27@GMAIL.COM
    Date Patient Qty Code
    INVOICE
    31/05/2022 Y00 Description
    31/05/2022 Y/00 PRACTITIONER: PETER ROEDIGER MIAid Patient Total
    31/05/2022 Y100 PATIENT: MISS Y JAMINE (00)
    31/05/2022 Y00 DATE OF BIRTH 21/06/2013
    11031 PEDIATRIC OPTOMETRIC EXAMINATION-
    SIMPLE CASE 800.00 800.00
    31/05/2022 Y/00
    ICD10 Z01.0/H52.2/H52.0/Z97.3
    31/05/2022 Y/00
    RIGHT LENS: DAMAR LAB 1.5 SURFACED
    31/05/2022 / 00 1 82BSO001
    UNCOATED
    -RL
    SINGLE VISION (SURFACED), S: +3.25, 760.0 760.00
    31/05/2022 00
    IcD10
    C:-0.50, X:118, A: 0.00
    31/05/2022 00 1 82LS081
    H52.2/H52.0/Z76.0
    31/05/2022 YI00 -RE.DAMAR LAB 1.5 SURFACED UNCOATED 172.00 172.00
    ICD10
    31/05/2022 YI00 H52.2/H52.0/276.0
    LEFT LENS DAMAR LAB 1.5 SURFACED
    31/05/2022 Y/00 1 82BS001
    UNCOATED
    LL:SINGLE VISION (SURFACED), S: +3.50 760.0 760.00
    31/05/2022 Y/O0 C:-0.75, X:60 , A: 0.00
    ICD10 H52.2/H52.0/Z76.0
    31/05/2022 Y/00 82LS081 -LE.DAMAR LAB 1.5 SURFACED UNCOATED 172.00 172.00
    31/05/2022 Y/00 ICD10
    31/05/2022 Y / 00
    H52.2/H52.0/Z76.0
    1 87LS00A RE. DAMAR LAB HARD
    31/05/2022 Y/00 COAT 457.0 457000
    ICD10 H52.2/H52.0/z76.0
    31/05/2022 Y/ 00 1 87LSOOA LE. DAMAR LAB HARD COAT 457.0 457.00
    31/05/2022 / 00 ICD10 H52.2/H52.0/Z76.0
    31/05/2022 Y/00 87UB0OC RE. UV400NM TREATMENT 0.00 1.00 251.0
    31/05/2022 Y/00 ICD10 H52.2/H52.0/Z76.0
    31/05/2022 YI00 1 87UBO0C LE. UV400NM TREATMENT 0.00 251.00 251.0
    31/05/2022 Y/00 ICD10 H52.2/H52.0/Z76.0
    31/05/2022 Y/00 40501 BOULDER OP129049321 1500.00
    1500.00
    31/05/2022 Y/ 00 ICD10 H52.2/H52.0/Z76.0
    31/05/2022 Y/00 1 11503 DISPENSING FEE - SINGLE VISION 120.00 120.00
    SURFACED
    31/05/2022 Y/00 ICD10 Z01.0/H52.2/H52.0/Z97.3
    Total: 0.00 5700.00 5700.00

    PRO
    Peter Roediger Optometrisf
    Prac No: 0022659
    011 728 3689
    74 African Street
    The Gardens, 2192

    PETER ROEDIGER OPTOM Member

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