Purchase Order Optometrist in United States Los Angeles –Free Word Template Download with AI
Optometrist Professional Services & Equipment Procurement
United States Los Angeles | Document Reference: PO-LA-2025-04872
Purchasing Party (Buyer)
Entity: Pacific Vision Care Group, LLC
Address: 4520 Wilshire Boulevard, Suite 300, Los Angeles, California 90010, United States
Contact: Dr. Margaret Chen, Practice Administrator
Phone: (213) 555-0147
Email: [email protected]
Tax ID (EIN): 82-4471903
Supplier / Vendor (Seller)
Entity: OptiSource Medical Supply Co.
Address: 1200 S. Grand Avenue, Los Angeles, California 90015, United States
Contact: Robert Tanaka, Sales Director
Phone: (323) 555-0892
Email: [email protected]
Tax ID (EIN): 74-2298316
Purchase Order Details| Purchase Order Number: | PO-LA-2025-04872 | Date of Issue: | June 12, 2025 |
| Required Delivery Date: | July 15, 2025 | Payment Terms: | Net 30 Days |
| Shipping Address: | 4520 Wilshire Boulevard, Suite 300, Los Angeles, CA 90010, United States | ||
| Valid Until: | July 12, 2025 | Currency: | USD (United States Dollar) |
| Item # | Description | Qty | Unit Price | Extended Price |
|---|---|---|---|---|
| 001 | Digital Phoropter (Nidek NP-200) – Primary diagnostic instrument for the Optometrist to perform comprehensive refraction examinations at the Los Angeles clinic | 2 | $18,500.00 | $37,000.00 |
| 002 | Non-Mydriatic Fundus Camera (Topcon TRC-NW6S) – For retinal imaging by the Optometrist during annual eye health screenings in United States Los Angeles | 1 | $42,750.00 | $42,750.00 |
| 003 | Optical Coherence Tomography (OCT) Scanner (Zeiss Cirrus HD-OCT) – Advanced diagnostic imaging for the Optometrist to detect glaucoma and macular degeneration | 1 | $58,200.00 | $58,200.00 |
| 004 | Autorefractor/Keratometer (Nidek ARK-530A) – Automated refraction measurement device for the Optometrist's patient intake workflow | 2 | $9,800.00 | $19,600.00 |
| 005 | Slit Lamp Biomicroscope (Topcon SL-18D) – Essential examination instrument for the Optometrist to evaluate anterior segment ocular pathology | 3 | $6,450.00 | $19,350.00 |
| 006 | Annual Calibration & Maintenance Service Contract for all Optometrist diagnostic equipment – Covers on-site service in United States Los Angeles | 1 | $12,400.00 | $12,400.00 |
| 007 | Optometrist Continuing Education & Certification Renewal Package – State of California Board of Optometry compliance documentation and training materials | 4 | $1,250.00 | $5,000.00 |
| 008 | Patient Examination Chairs (Ergonomic, adjustable) – For the Optometrist's consultation rooms at the Los Angeles practice facility | 6 | $2,800.00 | $16,800.00 |
| 009 | Frame & Lens Dispensing Equipment Package – Includes lens edger, frame adjuster, and trial lens set for the Optometrist's dispensing area | 1 | $24,600.00 | $24,600.00 |
| 010 | Electronic Health Records (EHR) Software License – Optometrist-specific module for patient records, prescription management, and insurance billing in United States Los Angeles | 5 | $3,200.00 | $16,000.00 |
| Subtotal: | $251,700.00 | |||
| Sales Tax (CA 9.5%): | $23,911.50 | |||
| Shipping & Installation (Los Angeles Metro): | $4,250.00 | |||
| TOTAL PURCHASE ORDER AMOUNT: | $279,861.50 | |||
- This Purchase Order is issued by Pacific Vision Care Group, LLC for the procurement of Optometrist diagnostic equipment, professional services, and related supplies for use at their clinic located in United States Los Angeles, California.
- All items listed in this Purchase Order must be delivered to the specified shipping address in Los Angeles, California, no later than the Required Delivery Date stated above. Late delivery beyond five (5) business days shall entitle the Buyer to a 2% per diem penalty on the total Purchase Order value.
- The Optometrist equipment listed herein must comply with all applicable Federal Food and Drug Administration (FDA) regulations, California State Board of Optometry standards, and applicable United States Los Angeles municipal health and safety codes.
- Payment shall be made within thirty (30) calendar days of receipt of a valid invoice and confirmed delivery of all items listed in this Purchase Order. Payment will be processed via ACH transfer to the vendor's designated bank account in the United States.
- All Optometrist diagnostic instruments are warranted for a minimum of twenty-four (24) months from the date of installation. The vendor shall provide on-site repair service within the United States Los Angeles metropolitan area within forty-eight (48) hours of a service request.
- The vendor acknowledges that all equipment purchased under this Purchase Order will be operated by a licensed Optometrist holding a valid California State Board of Optometry license. The vendor shall provide all necessary operator training for the Optometrist staff prior to final acceptance of the equipment.
- This Purchase Order is governed by the laws of the State of California and the United States of America. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in Los Angeles, California, in accordance with the rules of the American Arbitration Association.
- The vendor shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence for the duration of this Purchase Order and the associated warranty period.
- Any modifications to this Purchase Order must be made in writing and signed by authorized representatives of both parties. Verbal agreements regarding the Optometrist equipment or services listed herein shall be void.
- The vendor certifies that all products supplied under this Purchase Order are new, unused, and free from defects in material and workmanship, and are in full compliance with all applicable United States Los Angeles and California state regulations for medical and optical equipment.
By signing below, both parties acknowledge and agree to all terms, conditions, and line items specified in this Purchase Order for the Optometrist services and equipment procurement in United States Los Angeles.
For the Buyer (Pacific Vision Care Group, LLC):
Dr. Margaret Chen, Practice Administrator
Date: ____________________
For the Vendor (OptiSource Medical Supply Co.):
Robert Tanaka, Sales Director
Date: ____________________
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