PracticePlus Enrollment Application

  • Doing Business as Name
  • Legal Entity Name associated with your EIN. Please reference your tax forms if uncertain
  • EIN must be 9 digits / no hyphens please. Please reference tax forms if you are uncertain. NOTE: For practices with multiple locations operating under multiple EIN’s, please submit each via this form separately
  • This is the email that will receive all program communications
  • Email address of additional practice staff member/person you would like to be included to ensure a quick enrollment
  • Additional Practice Location Address(s)

    Please add the Address, Suite, City, State, Zip for EACH location that shares the same EIN. One primary location will be established per EIN. Points earned from other locations sharing the same EIN will roll up through primary location.
  • NameStreet AddressCityState 
    Add a new row
  • Wholesale Laboratory Suppliers

  • NameCityStateLab Account # 
    Add a new row
    Note: You MUST include the lab name and associated lab account #’s for all participating lab accounts associated with this practice address and any additional practice locations listed. Missing details will result in processing delays
  • W-9 Form Submission

    A W-9 Form signed by the Practice Owner is required as part of the enrollment process. Your enrollment will no be fully processed until we receive your completed W-9 form.
  • Fax Information

    Please fax the completed W-9 form to - 1-866-280-4586
  • Group Affiliation (only one please)

3 Things Current PracticePlus® Members Need to Know

  • July 31, 2023, is the absolute last day to submit fax and special handle claims for PracticePlus rewards.  
  • To continue earning PracticePlus rewards, you must be enrolled on Essilor Rewards Platform and activate PracticePlus offer by July 31, 2023.  
  • PracticePlus points can start earning the 1st of the following month after enrollment.


Complete Enrollment: Start Earning PracticePlus Rewards
June 1 – June 30, 2023 July 1, 2023
July 1 – July 31, 2023 August 1, 2023
August 1 – August 31, 2023 September 1, 2023

Don’t risk your future rewards. Call KODAK Lens (800) 830-3995 and start enrolling in PracticePlus today.   

Click Here to Enroll