Invoice Optometrist in Russia Moscow –Free Word Template Download with AI
Professional Optometry Services
12/5 Tverskaya Street, Building 3
Moscow, Russia, 125009
Phone: +7 (495) 123-45-67
Email: [email protected]
INN: 7701234567 | KPP: 770101001
OGRN: 1157746000123
Invoice Number: INV-2024-0892
Date Issued: October 24, 2024
Due Date: November 07, 2024
Payment Terms: Net 14
Bill To:
Alexei Petrovich Sokolov
Individual Consumer
45 Arbat Street, Apt 12
Moscow, Russia, 119002
Phone: +7 (916) 555-12-34
Email: [email protected]
Service Details:
Service Type: Comprehensive Optometric Examination
Optometrist: Dr. Elena Ivanova, Ph.D.
Licence Number: LO-77-01-012345
Appointment Date: October 24, 2024
Location: Moscow Vision Care Center, Main Clinic
| # | Description of Optometry Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 |
Comprehensive Eye Examination Includes visual acuity testing, refraction analysis, and binocular vision assessment performed by licensed optometrist in Moscow. |
1 | 4,500.00 | 4,500.00 |
| 2 |
Dilated Fundus Examination Retinal health assessment using advanced ophthalmoscopy equipment. Essential for detecting early signs of ocular conditions. |
1 | 3,200.00 | 3,200.00 |
| 3 |
Glaucoma Screening Intraocular pressure measurement (tonometry) and optic nerve evaluation. Standard preventive care in Russian optometry practice. |
1 | 2,800.00 | 2,800.00 |
| 4 |
Corneal Topography Mapping Digital mapping of corneal surface curvature for precise contact lens fitting and refractive surgery evaluation. |
1 | 3,500.00 | 3,500.00 |
| 5 |
Premium Anti-Reflective Coated Lenses High-index polycarbonate lenses with blue light filter, UV protection, and scratch-resistant coating. Custom ground prescription. |
1 | 12,000.00 | 12,000.00 |
| 6 |
Titanium Semi-Rimless Frame Lightweight, hypoallergenic titanium frame selected during consultation. Includes professional adjustment and fitting. |
1 | 8,500.00 | 8,500.00 |
| 7 |
Optometric Consultation & Prescription Detailed discussion of findings, vision correction recommendations, and official prescription documentation per Russian medical standards. |
1 | 1,500.00 | 1,500.00 |
This invoice represents professional optometry services rendered at our Moscow clinic in accordance with Russian Federation healthcare regulations. All examinations were conducted by certified optometrists holding valid medical licenses issued by the Moscow Department of Health. The prescription provided is valid for 12 months from the date of examination. Please retain this invoice for your records and potential insurance reimbursement. Our clinic adheres to all data protection requirements under Federal Law No. 152-FZ "On Personal Data." If you have any questions regarding the services provided or this invoice, please contact our billing department during business hours (Monday-Friday, 9:00-18:00 Moscow Time).
Payment Information:
Bank Name: Sberbank of Russia, JSC
Account Name: Moscow Vision Care Center LLC
Account Number: 40702810938000123456
BIC: 044525225
Correspondent Account: 30101810400000000225
SWIFT Code: SABRRUMM
Payment Reference: INV-2024-0892
Alternative payment methods accepted: Visa, MasterCard, MIR card, SBP (Fast Payment System), or cash at our Moscow clinic reception.
Authorized SignatureDr. Elena Ivanova
Chief Optometrist
Moscow Vision Care Center Received By
Alexei P. Sokolov
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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