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