2008-01-08 08:30:00 $-30.00 128818 $0.00 SEL V2204 1 8442 BF +/- 4.00 sph, 2.12 to 4.00 cyl Lens 367.1 0002513 0002513 8442 NEW 99999 SEL BF +/- 4.00 sph, 2.12 to 4.00 cyl Lens V2204 2454362 CBF 2007-12-17 $135.00 $135.00 2007-12-17 THP Professional Services 2 Self $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue ECA $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Private Patient Billing REV 2286 $-30.00 128818 $0.00 CHK PAYMT 1 8453 Check 201 0002513 0002513 8442 CLS 20001 CHK Check 201 PAYMT 2454457 CHK 2007-12-22 $-90.00 $-90.00 2007-12-17 BIL General Billing 2 Check $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue Brown DR. 631159628 $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Payments PMT 2286 $-30.00 128818 $0.00 SEL V2204 1 8443 BF +/- 4.00 sph, 2.12 to 4.00 cyl Lens 367.1 0002513 0002513 8443 NEW 99999 SEL BF +/- 4.00 sph, 2.12 to 4.00 cyl Lens V2204 2454362 CBF 2007-12-17 $135.00 $135.00 2007-12-17 THP Professional Services 2 Self $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue ECA $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Private Patient Billing REV 2286 $-30.00 128818 $0.00 CSH PAYMT 1 8454 Cash 0002513 0002513 8443 CLS 20001 CSH Cash PAYMT 2454457 CSH 2007-12-22 $-20.00 $-20.00 2007-12-17 BIL General Billing 2 Cash $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue Brown DR. 631159628 $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Payments PMT 2286 $-30.00 128818 $0.00 ADJ ADJST 1 8455 Discount 0002513 0002513 8443 CLS 20001 ADJ Discount ADJST 2454457 ADJ 2007-12-22 $-20.00 $-20.00 2007-12-17 BIL General Billing 2 Adjustments $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue Brown DR. 631159628 $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Adjustments ADJ 2286 $-30.00 128818 $0.00 SEL V2020 1 8444 Frames, purchases Add-on 367.1 0002513 0002513 8444 NEW 99999 MET CK583 10366 2454362 MET 2007-12-17 $345.00 $345.00 2007-12-17 THP Professional Services 2 Self $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com 10366 19 33 52 CK583 140 West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue ECA $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Private Patient Billing REV 2286 $-30.00 128818 $0.00 ADJ ADJST 1 8452 Discount 0002513 0002513 8444 CLS 20001 ADJ Discount ADJST 2454457 ADJ 2007-12-22 $-10.00 $-10.00 2007-12-17 BIL General Billing 2 Adjustments $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue Brown DR. 631159628 $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Adjustments ADJ 2286 $-30.00 128818 $90.00 FSA 92014 1 8445 OV- Est Pat comprehensive exam 367.1 0002513 0002513 8445 NEW 99999 FSA OV- Est Pat comprehensive exam 92014 2454362 FSA 2007-12-17 $0.00 $90.00 2007-12-17 THP Professional Services 1 Fee Schedule A $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue ECA $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Medical Insurance Revenue REV 2286 $-30.00 128818 $45.00 FSA 92012 1 8446 OV- Est Pat intermediate exam 367.1 0002513 0002513 8446 NEW 99999 FSA OV- Est Pat intermediate exam 92012 2454362 FSA 2007-12-17 $0.00 $45.00 2007-12-17 THP Professional Services 1 Fee Schedule A $135.00 $610.00 $135.00 $615.00 3165 Green Valley Road EyeCare Associates, Inc. Birmingham 205-967-2119 (205) 967-2103 35243 AL www.webeca.com West Vancouver Glenn Brand 91607- AL 6555 Nelson Avenue ECA $475.00 $110.00 6555 Nelson Avenue West Vancouver Glenn Primary Brand Medicare AL 91607- 2007-12-22 $750.00 Medical Insurance Revenue REV 2286