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Crystal Vision Optical Receipt

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Crystal Vision Optical

78 Elm Street
Madison, WI 53703
(608) 555-0194
crystal-vision.example

Sale

Optician: J. Gomez 02/04/2025 2:27 PM

Frames - Matte Tortoise169.0

Lenses - Single Vision (Hi-Index)120.0

Coating - Blue Light Filter45.0

Subtotal: 334.00
Tax: 26.72

Total: 360.72 • HSA

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