Medical Statement_of_charges_and_payments

Optical Shop Fee Slip 102661 Johan Jongsma

ID: 7afecac571f735bf

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Details

Category
Vendor
Optical Shop Inc
Amount
$0.00
Date
Jan 19, 2024
Processed
Sep 08, 2026 6:09 PM EDT
Original File
Scan_09082026_144014_000257.pdf

Summary

Statement of charges and payments from Optical Shop Inc for patient Johan Jongsma (Patient #14973), fee slip 102661, dated 01/19/2024. Total charges $624.00 were fully paid by Mastercard; balance due $0.00, no payment necessary.

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