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M LA OPTIK Menerima :

- Periksa Mata Gratis


- Berbagai Jenis Frame
- Lensa minus, plus, cylinder,
Jl. Rumah Sakit No.25 Kota Bandung. Telp. 0882001934191 Dable fokus, progresif DLL

Nama : ........................................................... Tanggal : ...........................................................


Alamat : ........................................................... Telp : ...........................................................

Frame : ............................................. Rp : .............................................


Rp : .............................................
Lensa : ............................................. Rp : .............................................
Resep : ............................................. Jumlah Rp : .............................................
Dp Rp : .............................................
Sisa Rp : .............................................
HASIL PEMERIKSAAN REFRAKSI
SPH CYL AXIS ADD PRISM Pemesan Hormat Kami
R
L
PD ( ) ( )

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