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Submission: On September 29 via manual from US — Scanned from DE
Form analysis
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<div class="form-group " data-type="text" data-required="false"> <select name="Preferred_Location" id="Preferred_Location" class="form-control" title="">
<option value="">Preferred Location</option>
<option value="The Meadow Mall Team">The Meadow Mall Team</option>
<option value="The Lake Mead Team">The Lake Mead Team</option>
<option value="The Fashion Show Mall Team">The Fashion Show Mall Team</option>
<option value="The St. Rose Team">The St. Rose Team</option>
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<div class="col-xs-12 ">
<div class="form-group required" data-validation="^(([0-9]{1})*[- .(]*([0-9]{3})[- .)]*[0-9]{3}[- .]*[0-9]{4})+$" data-errormsg="Invalid Phone Number" data-type="text" data-required="true"> <input name="Phone" value="" id="Phone"
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<div class="form-group " data-type="text" data-required="true"> <input name="Subject" value="" id="Subject" type="text" placeholder="Subject" class="form-control"></div>
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<div class="col-xs-12 form-each">
<div class="col-xs-12 ">
<div class="form-group " data-type="text" data-required="true"> <textarea name="Message" id="Message" placeholder="Message" class="form-control"></textarea></div>
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<div class="col-xs-12 ">
<div class="form-v2-notes">
<div style="text-align: center;">Please do not submit any Protected Health Information (PHI).</div>
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<div>
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<div class="container-fluid" style="padding: 0;">
<div class="alert alert-success" style="display: none;">Thank you! We will connect with you shortly.</div>
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<div class="alert alert-danger alert-custom-errors" style="display: none;">Dynamic Error Description</div>
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<div class="col-xs-12 ">
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type="text" placeholder="Phone Number" class="form-control"></div>
</div>
<div class="col-xs-12 ">
<div class="form-group required" data-validation="^[a-zA-Z0-9._%-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,4}$" data-errormsg="Invalid Email Address" data-type="text" data-required="true"> <input name="Email" value="" id="Email" type="text"
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<option value="8:00 am">8:00 am</option>
<option value="9:00 am">9:00 am</option>
<option value="10:00 am">10:00 am</option>
<option value="11:00 am">11:00 am</option>
<option value="1:00pm">1:00pm</option>
<option value="2:00pm">2:00pm</option>
<option value="3:00pm">3:00pm</option>
<option value="4:00pm">4:00pm</option>
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<div class="form-group " data-type="text" data-required="true"> <textarea name="Message" id="Message" placeholder="Message" class="form-control"></textarea></div>
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<div class="form-group" data-type="submit"> <input type="submit" class="ry-btn ry-btn-primary" value="Submit"></div>
</div>
<div class="container-fluid" style="padding: 0;">
<div class="alert alert-success" style="display: none;">Thank you. We will connect with you shortly.</div>
<div class="alert alert-danger alert-missing-fields" style="display: none;">You are missing required fields.</div>
<div class="alert alert-danger alert-custom-errors" style="display: none;">Dynamic Error Description</div>
<div class="alert alert-danger alert-processing-error" style="display: none;">There was an error processing this form.</div>
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POST /login
<form method="post" action="/login" accept-charset="UTF-8"> <input type="hidden" name="login_filter_action" value="login"><input id="_login_email" class="form-control" type="text" placeholder="Email" name="email"><input id="_login_password"
class="form-control" type="password" placeholder="Password" name="password"><input class="btn btn-default btn-login" type="submit" value="Login"><br><a href="#" class="forgotPasswordLink">Forgot Password?</a> <br>
<h3>OR</h3>
<div class="social-btns">
<a href="https://admin.roya.com/front-site/hybrid-login/?site=Site-4c05a82e-2785-4b4e-afc8-e52b099647a5&service=Facebook&ts=1664478257&ref=https%3A%2F%2Fwww.lasvegaseyedocs.com%2F%3Furl%3D%26isaDirectory%3Dtrue&token=e58dab60395de1983405ea66ff77d52d08552627158c4236806e0cb51ef9236b" class="btn btn-lg col-xs-12 btn-social btn-facebook v-margin-5"><span class="fa fa-facebook"></span> Sign in with Facebook</a><a href="https://admin.roya.com/front-site/hybrid-login?site=Site-4c05a82e-2785-4b4e-afc8-e52b099647a5&service=Google&ts=1664478257&ref=https%3A%2F%2Fwww.lasvegaseyedocs.com%2F%3Furl%3D%26isaDirectory%3Dtrue&token=14dfbfbce0137c206078cae19cffc1e9ee13e38a19783b2630eb33b010e9d85a" class="btn btn-lg col-xs-12 btn-social btn-google v-margin-5"><span class="fa fa-google"></span> Sign in with Google</a>
</div>
</form>
POST /forgotPassword
<form method="post" action="/forgotPassword" accept-charset="UTF-8" class="forgotPasswordForm" style="display: none;"> <input type="hidden" name="login_filter_action" value="forgot"><br>
<div class="resetPassworderror"></div> <br><input id="_forgotPassword_email" class="form-control" type="text" placeholder="Email" name="email"><input class="btn btn-default btn-resetPassword" type="submit" value="Send new password">
</form>
POST /register
<form method="post" action="/register" accept-charset="UTF-8"> <input type="hidden" name="login_filter_action" value="register"><input id="_register_email" class="form-control" type="text" placeholder="Email" name="email"><input
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class="form-control" type="text" placeholder="Phone" name="phone"><input id="_register_password" class="form-control" type="password" placeholder="Password" name="password"><input id="_register_password_confirmation" class="form-control"
type="password" placeholder="Repeat Password" name="password_confirmation"><input class="btn btn-default btn-register" type="submit" value="Create account"></form>
POST /saveSearch
<form method="post" action="/saveSearch" accept-charset="UTF-8"> <input id="_saved_search_name" class="form-control" type="text" placeholder="Name your search" name="saved_search_name"><br><input class="btn btn-primary btn-save-search" type="submit"
value="Save"></form>
POST /updateProfile
<form method="post" action="/updateProfile" accept-charset="UTF-8" class="form-horizontal"> <input type="hidden" name="login_filter_action" value="update-profile"><input type="hidden" name="_id" value="">
<div class="form-group"> <label for="_updateProfile_email" class="col-sm-3 control-label">Email</label>
<div class="col-sm-9"> <input id="_updateProfile_email" class="form-control" type="text" placeholder="" name="email" value=""></div>
</div>
<div class="form-group"> <label for="_updateProfile_firstname" class="col-sm-3 control-label">Name</label>
<div class="col-sm-9"> <input id="_updateProfile_firstname" class="form-control" type="text" placeholder="" name="name" value=""></div>
</div>
<div class="form-group"> <label for="_updateProfile_password" class="col-sm-3 control-label">Password</label>
<div class="col-sm-9"> <input id="_updateProfile_password" class="form-control" type="password" placeholder="leave empty to remain unchanged" name="password"></div>
</div>
<div class="form-group"> <label for="_updateProfile_password_confirmation" class="col-sm-3 control-label">Confirm Password</label>
<div class="col-sm-9"> <input id="_updateProfile_password_confirmation" class="form-control" type="password" placeholder="leave empty to remain unchanged" name="password_confirmation"></div>
</div>
<div class="form-group">
<div class="col-sm-offset-2 col-sm-10"> <input class="btn btn-primary btn-update-profile pull-right" type="submit" value="Update Your Profile"></div>
</div>
</form>
Text Content
Skip to main contentEnable accessibility for visually impairedOpen the accessibility menu Menu * Menu * Home * Open submenu ( About Us) About Us * Open submenu ( Services) Services * Open submenu ( Patient Center) Patient Center * Open submenu ( Pearle Vision) Pearle Vision * Open submenu ( LensCrafters) LensCrafters * Contact Us Close submenu About Us * Our Eye Doctors * Community Partners * Blog Close submenu Services * Open submenu (Comprehensive Vision Exam)Comprehensive Vision Exam * Open submenu (Comprehensive Medical Exam)Comprehensive Medical Exam * Open submenu (Contact Lens Services)Contact Lens Services Close submenuComprehensive Vision Exam * Vision Screening * Computer Vision Syndrome * Sports Vision * Optos Retinal Exam * Pediatric Vision Exams * Nearsighted Vision Treatment * Vision Screener * Farsighted Vision Treatment * Eyeglass and Lenses Close submenuComprehensive Medical Exam * Eye Conditions * Foreign Body Removal * Diabetic Retinopathy * Cataract Treatment * Macular Degeneration * Glaucoma Treatment * Dry Eye Treatment * Cancer of the Lids & Eye * Blurry Vision * Astigmatism * Eye Floaters * Eye Infections * Eye Allergies * Keratoconus * Low Vision * Nearsightedness and Farsightedness * Pink Eye Close submenuContact Lens Services * Specialty Contact Lens Services * Contact Lenses for Astigmatism * Hard to Fit Contacts Close submenu Patient Center * Open submenu (Insurance & Financing)Insurance & Financing * Patient Portal * Survey * VIP Vision Plan * Telemedicine Close submenuInsurance & Financing * Vision VS Medical Insurance * Pay Your Bill Online * CareCredit * Sunbit Financing Close submenu Pearle Vision * Pearle Vision at Green Valley * Pearle Vision at Maryland Parkway * Pearle Vision at Nellis Blvd * Pearle Vision at N. Rainbow * Pearle Vision at Rampart * Pearle Vision at Sahara Ave * Pearle Vision at Sunset Rd * Pearle Vision at S. Rainbow * Pearle Vision at Tropicana * Pearle Vision at Valle Verde * Pearle Vision at Windmill * Pearle Vision at Flamingo Close submenu LensCrafters * Galleria Mall Inside LensCrafters * Lake Mead Inside LensCrafters * Meadows Mall Inside LensCrafters * St. Rose Inside LensCrafters - South Fork Pointe Request an Appointment PEARLE VISION Appointment LENSCRAFTERS Appointment Pearle Vision Locations (702) 452-2020 LensCrafters Locations (702) 341-7254 * Home * About Us * Our Eye Doctors * Community Partners * Blog * Services * Comprehensive Vision Exam * Vision Screening * Computer Vision Syndrome * Sports Vision * Optos Retinal Exam * Pediatric Vision Exams * Nearsighted Vision Treatment * Vision Screener * Farsighted Vision Treatment * Eyeglass and Lenses * Comprehensive Medical Exam * Eye Conditions * Foreign Body Removal * Diabetic Retinopathy * Cataract Treatment * Macular Degeneration * Glaucoma Treatment * Dry Eye Treatment * Cancer of the Lids & Eye * Blurry Vision * Astigmatism * Eye Floaters * Eye Infections * Eye Allergies * Keratoconus * Low Vision * Nearsightedness and Farsightedness * Pink Eye * Contact Lens Services * Specialty Contact Lens Services * Contact Lenses for Astigmatism * Hard to Fit Contacts * Patient Center * Insurance & Financing * Vision VS Medical Insurance * Pay Your Bill Online * CareCredit * Sunbit Financing * Patient Portal * Survey * VIP Vision Plan * Telemedicine * Pearle Vision * Pearle Vision at Green Valley * Pearle Vision at Maryland Parkway * Pearle Vision at Nellis Blvd * Pearle Vision at N. Rainbow * Pearle Vision at Rampart * Pearle Vision at Sahara Ave * Pearle Vision at Sunset Rd * Pearle Vision at S. Rainbow * Pearle Vision at Tropicana * Pearle Vision at Valle Verde * Pearle Vision at Windmill * Pearle Vision at Flamingo * LensCrafters * Galleria Mall Inside LensCrafters * Lake Mead Inside LensCrafters * Meadows Mall Inside LensCrafters * St. Rose Inside LensCrafters - South Fork Pointe * Contact Us PEARLE VISION (702) 452-2020 LENSCRAFTERS (702) 341-7254 PEARLE VISION Appointment LENSCRAFTERS Appointment HERO LAS VEGAS EYE DOCS Serving the Community since 1993 Schedule Your Eye Exam CTA pay bill online [LINK] Online Vision Screener [LINK] Sunbit Financing [LINK] Patient Portal [LINK] WELCOME WELCOME TO KOPOLOW & GIRISGEN DOCTORS OF OPTOMETRY A full service Las Vegas eye doctor and eye care center. Whether you need to get new glasses or contacts, or have any other vision and eye health need, our optometrists in Las Vegas and Henderson are here for you. Please read on for more information about the services that Drs. Kopolow and Girisgen provide. Learn More ABOUT OUR LAS VEGAS OPTOMETRIST SERVICES At Kopolow & Girisgen Doctors of Optometry, we strive to meet your vision and eye health needs using the latest technologies and equipment. Our optometrists stay current with new routines and vision care procedures, offer the newest services to preserve your vision and eye health, and offer flexible payment options. We consider ourselves to be a family practice, and treat both adults and children with vision needs. View Services SERVICES Comprehensive Vision Exam Comprehensive Medical Exam Contact Lens Services [LINK] Visual Performance Center of Nevada * Vision Screening * Computer Vision Syndrome * Sports Vision * Optos Retinal Exam * Pediatric Vision Exams * Nearsighted Vision Treatment * Vision Screener * Farsighted Vision Treatment * Eyeglass and Lenses * Eye Conditions * Foreign Body Removal * Diabetic Retinopathy * Cataract Treatment * Macular Degeneration * Glaucoma Treatment * Dry Eye Treatment * Cancer of the Lids & Eye * Blurry Vision * Astigmatism * Eye Floaters * Eye Infections * Eye Allergies * Keratoconus * Low Vision * Nearsightedness and Farsightedness * Pink Eye * Specialty Contact Lens Services * Contact Lenses for Astigmatism * Hard to Fit Contacts MEET THE DOCTORS EYE DOCTORS IN LAS VEGAS MEET THE DOCTORS We take pride in being Eye Doctors in Las Vegas for as long as we have been. We operate 13 eye care centers here in Las Vegas to make it easy to help you with all your eye care needs. We make it a policy to ensure that all staff members are up-to-date on the latest technology and techniques related to the eye care industry, to make your visit as comfortable and effective as possible. Dr. Linda M. Bayerkohler Dr. Michael Roth Dr. Phillip J. Duran Dr.H Kenneth Kopolow Dr. Steve Girisgen Dr. Frances Capulong-Jones Dr. Abraham Motola Dr. Amy Lelei Apisa Hitzeman Dr. Bruce Feinberg Dr. Christopher Tom Dr. Cindy Trinh Dr. Dong Chan Suk Dr. Kelli Anne McLaughlin Dr. Lawrence Cruz Dr. Linda M. Bayerkohler Dr. Michael Roth Dr. Phillip J. Duran Dr.H Kenneth Kopolow Dr. Steve Girisgen Dr. Frances Capulong-Jones Read More CONTACT US Preferred LocationThe Meadow Mall TeamThe Lake Mead TeamThe Fashion Show Mall TeamThe St. Rose TeamThe Galleria Mall TeamThe N. Rainbow TeamThe S. Rainbow TeamThe Boulevard TeamThe Tropicana TeamThe Sunset TeamThe Sahara TeamThe Nellis TeamThe Billing TeamThe Valle Verde Team Please do not submit any Protected Health Information (PHI). Thank you! We will connect with you shortly. You are missing required fields. Dynamic Error Description There was an error processing this form. © 2022 Kopolow & Girisgen Doctors of Optometry. All rights Reserved. Accessibility Statement - Privacy Policy - Sitemap Powered by: × APPOINTMENT REQUEST Please use the form below to request an appointment. Our team will connect with you shortly to confirm your appointment. Thank you! 8:00 am9:00 am10:00 am11:00 am1:00pm2:00pm3:00pm4:00pm Thank you. We will connect with you shortly. You are missing required fields. Dynamic Error Description There was an error processing this form. × THANK YOU! We've copied your review, after you click 'Publish' please paste your review by selecting 'ctrl' + 'v' into the review comments section. Publish to Social Close none 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM Closed Closed optometrist 7024522020 Mon-Sat 9am-6pm Sun 10am-5pm 7023417254 Mon-Sat 10am-6pm Sun 11am-5pm Lake Mead Inside LensCrafters 7361 W Lake Mead Blvd # 104 Las Vegas, NV 89128 9460 W. Flamingo Rd Ste# 100 Las Vegas, NV 89147 Meadows Mall Inside LensCrafters 4300 Meadows Ln #126 Las Vegas, NV Las Vegas, NV, 89107 St. Rose Inside LensCrafters - South Fork Pointe 9975 S Eastern Ave #100 Las Vegas, NV, 89183 Galleria Mall Inside LensCrafters 1300 W Sunset Rd #1617 Henderson, NV, 89014 Pearle Vision at N Green Valley Pkwy 1000 N Green Valley Pkwy. Suite 420 Henderson, NV 89074 Pearle Vision at S Maryland Pkwy 9770 S Maryland Pkwy. Suite 10 Las Vegas, NV 89183 Pearle Vision at Nellis Blvd 230 N Nellis Blvd Las Vegas, NV 89110 Pearle Vision at Sunset Rd 1381 W. Sunset Rd Suite 120 Henderson, NV, 89014 Pearle Vision at Sahara Ave 8145 W Sahara Ave #510 Las Vegas, NV, 89117 Pearle Vision at Tropicana 6160 W. Tropicana Ave Suite E-4 Las Vegas, NV, 89103 Pearle Vision at N. Rainbow 2021 N Rainbow Blvd #100 Las Vegas, NV, 89108 Pearle Vision at S. Rainbow 7090 S. Rainbow. Blvd Suite 100 Las Vegas, NV, 89118 Pearle Vision at Valle Verde 75 S. Valle Verde Pkwy. Suite # 100 Henderson, NV 89012 Pearle Vision at Rampart Blvd 2279 N Rampart Blvd. Las Vegas, NV 89128 Pearle Vision at Windmill 8025 S Rainbow Blvd. Suite 104 Las Vegas, NV 89139 × LOGIN Forgot Password? OR Sign in with Facebook Sign in with Google Looking to create an account ? Already have an account? Login × SAVE SEARCH × SAVED SEARCHES × MODAL TITLE One fine body… Close Save changes × UPDATE PROFILE Email Name Password Confirm Password