frame brochure for alabama medicaid agency · pdf fileframe brochure for alabama medicaid...
TRANSCRIPT
FRAME BROCHURE
for
Alabama Medicaid Agency
Effective 9/01/2017
Revised 3/14/2018
Classic Optical Laboratories, Inc.
3710 Belmont Avenue, Youngstown, OH 44505
Phone: 888.522.2020 / Fax: 330.759.8300
www.classicoptical.com
Additions
FRAMES ADDED 9/01/2017
7716 FX1 L8028
7725 FX3 L8029
7726 FX4 L8030
7731 FX6 Launch
5th Avenue FX8 LTD 181
Active FX10 Manhattan
Adorable FX13 Media
Amber FX15 Metropolitan
Answer FX20 Monaco
Appeal FX22 Natalie
Bashful FX27 Now
Beginner FX28 Pacific
Bicycle FX29 Patches
BLVD4154 FX30 Patience
Brian FX32 Phase
Buzz FX33 Pleasure
Cambridge FX34 PT92
Candia Glenn Relax
Catchy Goodies Rigid
Climb Harper S-310
Clutch Hector S-512
Compliment Holiday Sheer
Concert Incognito Skippy
Confetti Keith Split A
Dance L6016 Split C
Degree L6017 Spunky
Exclusive 119 L6018 Studio
Exclusive 157 L7015 SW319
Feline L7016 T18
Floral L7017 T28
Forbidden L8026 T30
Freedom L8027 Tackle
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 1 of 83 Pages
Additions
Taffy U205 US73
Takeoff U208 US78
Tender UL90 US80
Thrive UM73 Wow
U31 Unite Yippee
U35 Uptown Yoni
U40 US54 Youth
U203 US67
FRAMES ADDED 1/01/2017
Agree
EQ 301
EQ 313
Model 15
SW 444
SW 445
Urban
US 53
US 74
US 75
FRAME ADDED 3/28/2016
Nick 53
FRAMES ADDED 11/01/2015
Care
Chill
Cosmo
Equal
Jazz
Launch
Parallel
Score
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 2 of 83 Pages
Additions
FRAMES ADDED 04/15/2015
Baby Plus
Baby Plus 2
Eva
New Baby 4
Nick 50
FRAMES ADDED 01/01/2015
L6001 L8001
L6002 L8002
L6003 L8003
L6004 L8004
L6005 L8005
L6006 L8006
L6007 L8007
L6008 L8008
L6009 L8009
L6010 L8010
L6011 L8011
L6012 L8012
L7001 L8013
L7002 L8014
L7003 L8015
L7004 L8016
L7005 L8017
L7006 L8018
L7007 L8019
L7008 L8020
L7009 L8021
L7010 L8022
L7011 L8023
L7012 L8024
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 3 of 83 Pages
Additions
FRAMES ADDED 11/01/2014
Baby Zero Maxi Baby 2 Model 9
Baby Zero 2 Nicki 48 Model 10
Baby One 37 Nick 52 Model 11
Baby Lux Model 1 Model 12
Baby Lux2 Model 2 Model 13
Baby One 44 Model 3 Model 14
New Baby 1 Model 4
New Baby 2 Model 5
New Baby 3 Model 6
Mini Baby Model 7
Maxi Baby Model 8
FRAMES ADDED 7/1/2014
7710 PT 85
Banzai PT 86
Cyclone PT 87
Diana Rori
Finesse Storm
Gemini Vern
Positive Vibe
Precise Wisdom
PT 84
FRAMES ADDED 9/1/2013
Anne
EL-126
Theory
FRAMES ADDED 1/22/2013
PT 89
Mainstreet 415
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 4 of 83 Pages
Additions
FRAMES ADDED 11/1/2012
7712 Monica UM 72
Bria Pixie US 50
Camille Plasma US 51
Capricorn PT36 US 56
Caribbean PT 56 US 57
Carousel PT 61 US 65
Chad PT 62 Visa
Chris PT 79 Whimsy
Connie PT 80
CT 2294 Randi
CT 436 Sadie
Dawn Sky
Dynamite Slick
Eileen Slide
Emma Smart
Falcon Speckle
Genius Structure
Hannah Swift
Heat Swirl
Helen Tactic
Hide & Seek Tigress
Hudson Todd
Ivy Tornado
James U 14
Joseph U 21
Keynote U 23
Kiwi U 28
Lisa U 36
Lollipop - Skull U 37
Lollipop - Cable U 39
Mingle UM 70
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 5 of 83 Pages
Additions
FRAMES ADDED 11/15/2011
7719 Prize
Adam PT 62
Aries PT 67
Beth PT 72
Clout Shock
Debbie Sneakers
Doug Special
Ethel Splash
G500 Sporty
Icon Tie-Dye
Iris Tori
Kensington U 32
Kody U 33
Lilac U10
Lulu UL 91
Nancy US 55
Neon US 56
Ninja Wiggle
Overview Windy
Preston
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 6 of 83 Pages
Deletions
FRAMES DELETED 7/1/2017
Positive
Wisdom
FRAMES DELETED 1/01/2017
Adventure
Buddy
CC 53
Chad
Debbie
Electra
Exclusive 135
Fission 9
G 500
Kidco 5
Kidco 6
Leo #2
Preston
Prize
S 324
FRAME DELETED 4/14/2016
El-126
FRAME DELETED 3/28/2016
Nick 52
FRAME DELETED 1/26/2016
G500
FRAME DELETED 1/14/2016
Model 10
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 7 of 83 Pages
Deletions
FRAME DELETED 1/5/2016
Exclusive 90
FRAME DELETED 4/29/2015
CC 52
FRAME DELETED 10/10/2014
J5606
FRAME DELETED 7/1/2014
Iris
FRAME DELETED 2/25/2014
J5616
FRAME DELETED 2/19/2014
Overvue
FRAME DELETED 10/16/2013
CC42
FRAME DELETED 2/19/2013
CC37
FRAMES DELETED 1/21/2013
905
911
FRAME DELETED 11/1/2012
PT 72 (all colors)
FRAME DELETED 10/2/2012
PT 72 (Ink)
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 8 of 83 Pages
Deletions
FRAME DELETED 4/1/2012
901
J5638
FRAMES DELETED 1/1/2011
314 Gusto Monaco S-502
Anika Hunter Monica Star
Atlantic J 5603 Ontario Uptown
Blvd 4170 J 5631 Overlook
Blvd 4508 Johnny Panda CCS
Christy Karen S-301
Dillon Kennedy S-302
Downtown Lcable S-305
Fission 20 Manchester S-310
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 9 of 83 Pages
Women's Frame List
Style Manufacturer Material Price
7726 Capri Optics Metal 9.95$
14th Ave. Limited Editions Plastic 9.95$
Active Modern Optical Plastic 9.95$
Adorable Modern Optical Plastic 9.95$
Amber Modern Optical Plastic 9.95$
Anne Modern Optical Plastic 9.95$
Answer Modern Optical Plastic 9.95$
Appeal Modern Optical Plastic 9.95$
Attitude 18 Zimco Optics Plastic 9.95$
Beth Modern Optical Metal 9.95$
BLVD4154 New York Eye Metal 9.95$
Bria Modern Optical Metal 9.95$
Buzz Modern Optical Plastic 9.95$
Camille Modern Optical Metal 9.95$
Candia Limited Editions Plastic 9.95$
Carousel Modern Optical Plastic 9.95$
Catchy Modern Optical Plastic 9.95$
CC 61 Zimco Optics Plastic 9.95$
Certain Modern Optical Plastic 9.95$
Clutch Modern Optical Plastic 9.95$
Compliment Modern Optical Plastic 9.95$
Concert Modern Optical Plastic 9.95$
Connie Modern Optical Plastic 9.95$
CT 2294 Limited Editions Metal 9.95$
Dance Modern Optical Plastic 9.95$
Dawn Modern Optical Metal 9.95$
Dazzle Modern Optical Metal 9.95$
Degree Modern Optical Plastic 9.95$
Diana Modern Optical Metal 9.95$
Eileen Modern Optical Plastic 9.95$
Emma Modern Optical Plastic 9.95$
Ethel Modern Optical Metal 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 10 of 83 Pages
Women's Frame List
Style Manufacturer Material Price
Feline Modern Optical Plastic 9.95$
Finesse Modern Optical Metal 9.95$
Floral Modern Optical Plastic 9.95$
Forbidden Modern Optical Plastic 9.95$
Freedom Modern Optical Plastic 9.95$
Fregossi 368 Continental Optical Plastic 9.95$
Gift Modern Optical Plastic 9.95$
Gloria Modern Optical Metal 9.95$
Hannah Modern Optical Plastic 9.95$
Harper Modern Optical Plastic 9.95$
Helen Modern Optical Plastic 9.95$
Holiday Modern Optical Plastic 9.95$
Incognito Modern Optical Plastic 9.95$
J 5602 Hart Specialties Metal 9.95$
Judi Modern Optical Plastic 9.95$
Karma Modern Optical Plastic 9.95$
L6001 Lantis Plastic 9.95$
L6002 Lantis Plastic 9.95$
L6003 Lantis Plastic 9.95$
L6004 Lantis Plastic 9.95$
L6005 Lantis Metal 9.95$
L6006 Lantis Metal 9.95$
L6007 Lantis Metal 9.95$
L6008 Lantis Plastic 9.95$
L6009 Lantis Metal 9.95$
L6010 Lantis Metal 9.95$
L6011 Lantis Metal 9.95$
L6012 Lantis Metal 9.95$
L6016 Lantis Plastic 9.95$
L6017 Lantis Plastic 9.95$
L6018 Lantis Plastic 9.95$
Lilac Capri Optics Metal 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 11 of 83 Pages
Women's Frame List
Style Manufacturer Material Price
Lisa Modern Optical Metal 9.95$
Liz Zimco Optics Metal 9.95$
LTD181 Limited Editions Metal 9.95$
Lulu Modern Optical Plastic 9.95$
Manhattan Limited Editions Plastic 9.95$
Media Modern Optical Plastic 9.95$
Metropolitan Modern Optical Plastic 9.95$
Mingle Modern Optical Plastic 9.95$
Monaco Zimco Optics Metal 9.95$
Monica Modern Optical Plastic 9.95$
Nancy Modern Optical Metal 9.95$
Natalie Modern Optical Plastic 9.95$
Now Modern Optical Plastic 9.95$
Parallel Modern Optical Plastic 9.95$
Patience Modern Optical Plastic 9.95$
Phase Modern Optical Plastic 9.95$
Pixie Modern Optical Plastic 9.95$
Pleasure Modern Optical Plastic 9.95$
PT 62 Capri Optics Metal 9.95$
PT 79 Capri Optics Metal 9.95$
PT 80 Capri Optics Metal 9.95$
PT 86 Capri Optics Metal 9.95$
Randi Modern Optical Metal 9.95$
Relax Modern Optical Plastic 9.95$
Rigid Modern Optical Plastic 9.95$
Rori Modern Optical Plastic 9.95$
S-310 Zimco Optics Plastic 9.95$
S-313 Zimco Optics Plastic 9.95$
Sadie Modern Optical Plastic 9.95$
Sheer Modern Optical Plastic 9.95$
Studio Modern Optical Plastic 9.95$
SW319 EyeQ Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 12 of 83 Pages
Women's Frame List
Style Manufacturer Material Price
SW445 EyeQ Plastic 9.95$
Swirl Modern Optical Plastic 9.95$
Takeoff Modern Optical Plastic 9.95$
Tender Modern Optical Plastic 9.95$
Thrive Modern Optical Plastic 9.95$
Tigress Modern Optical Plastic 9.95$
U 14 Capri Optics Plastic 9.95$
U 28 Capri Optics Plastic 9.95$
U 31 Capri Optics Plastic 9.95$
U 35 Capri Optics Plastic 9.95$
U 37 Capri Optics Plastic 9.95$
U 40 Capri Optics Plastic 9.95$
U 203 Capri Optics Plastic 9.95$
U 205 Capri Optics Plastic 9.95$
U 208 Capri Optics Plastic 9.95$
UL 90 Capri Optics Plastic 9.95$
UL 91 Capri Optics Plastic 9.95$
Unite Modern Optical Plastic 9.95$
Uptown Limited Editions Plastic 9.95$
US 50 Capri Optics Plastic 9.95$
US 51 Capri Optics Plastic 9.95$
US 53 Capri Optics Plastic 9.95$
US 54 Capri Optics Plastic 9.95$
US 56 Capri Optics Plastic 9.95$
US 57 Capri Optics Plastic 9.95$
US 65 Capri Optics Plastic 9.95$
US 67 Capri Optics Plastic 9.95$
US 73 Capri Optics Plastic 9.95$
US 74 Capri Optics Plastic 9.95$
US 80 Capri Optics Plastic 9.95$
Wow Modern Optical Plastic 9.95$
Yippee Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 13 of 83 Pages
Men's Frame List
Style Manufacturer Material Price
7719 Capri Optics Metal 9.95$
7726 Capri Optics Metal 9.95$
Active Modern Optical Plastic 9.95$
Adam Modern Optical Plastic 9.95$
Answer Modern Optical Plastic 9.95$
Appeal Modern Optical Plastic 9.95$
Brave Modern Optical Plastic 9.95$
Buzz Modern Optical Plastic 9.95$
Caribbean Zimco Optics Metal 9.95$
Catchy Modern Optical Plastic 9.95$
Clout Modern Optical Plastic 9.95$
Clutch Modern Optical Plastic 9.95$
Concert Modern Optical Plastic 9.95$
Degree Modern Optical Plastic 9.95$
Doug Modern Optical Metal 9.95$
Exclusive 119 Continental Optical Metal 9.95$
Exclusive 120 Continental Optical Metal 9.95$
Exclusive 157 Continental Optical Metal 9.95$
Forbidden Modern Optical Plastic 9.95$
Freedom Modern Optical Plastic 9.95$
Glenn Modern Optical Metal 9.95$
Harper Modern Optical Plastic 9.95$
Heat Modern Optical Metal; Nylon
Rimless 9.95$
Hector Modern Optical Plastic 9.95$
Icon Modern Optical Metal 9.95$
Ivy Capri Optics Metal 9.95$
James Modern Optical Metal 9.95$
Joseph Modern Optical Metal 9.95$
Keith Modern Optical Metal 9.95$
Kody Modern Optical Metal 9.95$
L7001 Lantis Metal 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 14 of 83 Pages
Men's Frame List
Style Manufacturer Material Price
L7002 Lantis Plastic 9.95$
L7003 Lantis Metal 9.95$
L7004 Lantis Metal 9.95$
L7005 Lantis Metal 9.95$
L7006 Lantis Plastic 9.95$
L7007 Lantis Plastic 9.95$
L7008 Lantis Plastic 9.95$
L7009 Lantis Metal 9.95$
L7010 Lantis Metal 9.95$
L7011 Lantis Metal 9.95$
L7012 Lantis Metal 9.95$
L7015 Lantis Plastic 9.95$
L7016 Lantis Plastic 9.95$
L7017 Lantis Plastic 9.95$
Media Modern Optical Plastic 9.95$
Metropolitan Modern Optical Plastic 9.95$
Moscow Zimco Optics Metal 9.95$
Now Modern Optical Plastic 9.95$
Overview Modern Optical Plastic 9.95$
Pacific Zimco Optics Plastic 9.95$
Plasma Modern Optical Plastic 9.95$
PT 36 Capri Optics Metal 9.95$
PT 48 Capri Optics Metal 9.95$
PT 56 Capri Optics Metal 9.95$
PT 85 Capri Optics Metal 9.95$
PT 92 Capri Optics Metal 9.95$
Ralph Modern Optical Plastic 9.95$
Relax Modern Optical Plastic 9.95$
S-510 Zimco Optics Metal 9.95$
Studio Modern Optical Plastic 9.95$
Swift Modern Optical Metal 9.95$
Tactic Modern Optical Metal 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 15 of 83 Pages
Men's Frame List
Style Manufacturer Material Price
Ted (CC Temple) Modern Optical Metal; Cable
Temples 9.95$
Thrive Modern Optical Plastic 9.95$
Tornado Modern Optical Plastic 9.95$
U 32 Capri Optics Plastic 9.95$
U 203 Capri Optics Plastic 9.95$
U 205 Capri Optics Plastic 9.95$
UM 72 Capri Optics Plastic 9.95$
UM 73 Capri Optics Plastic 9.95$
Unite Modern Optical Plastic 9.95$
Uptown Limted Editions Plastic 9.95$
US 54 Capri Optics Plastic 9.95$
US 67 Capri Optics Plastic 9.95$
US 73 Capri Optics Plastic 9.95$
US 80 Capri Optics Plastic 9.95$
Vern Modern Optical Metal 9.95$
Visa Modern Optical Plastic 9.95$
Wow Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 16 of 83 Pages
Girls Frame List
Style Manufacturer Material Price
7716 Capri Optics Metal 9.95$
7725 Capri Optics Metal 9.95$
7731 Capri Optics Metal 9.95$
5th Avenue Limited Editions Metal 9.95$
Adorable Modern Optical Plastic 9.95$
Bashful Modern Optical Plastic 9.95$
Bicycle Modern Optical Plastic 9.95$
Cambridge Zimco Optics Plastic 9.95$
Certain Modern Optical Plastic 9.95$
Climb Modern Optical Plastic 9.95$
Confetti Modern Optical Plastic 9.95$
Curly Limited Editions Metal 9.95$
Cutie Modern Optical Metal 9.95$
Gift Modern Optical Plastic 9.95$
Goodies Modern Optical Plastic 9.95$
Incognito Modern Optical Plastic 9.95$
Kiwi Capri Optics Metal 9.95$
LTD181 Limited Editions Metal 9.95$
Patches Modern Optical Plastic 9.95$
PT 67 Capri Optics Metal 9.95$
Pumpkin - Cable Modern Optical Metal 9.95$
Pumpkin - Skull Modern Optical Metal 9.95$
Rigid Modern Optical Plastic 9.95$
S-512 Zimco Optics Metal 9.95$
Skippy Modern Optical Plastic 9.95$
Spunky Modern Optical Plastic 9.95$
SW319 EyeQ Plastic 9.95$
SW445 EyeQ Plastic 9.95$
Tackle Modern Optical Plastic 9.95$
Taffy Modern Optical Plastic 9.95$
Tender Modern Optical Plastic 9.95$
Tori Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 17 of 83 Pages
Girls Frame List
Style Manufacturer Material Price
U 10 Capri Optics Plastic 9.95$
U 31 Capri Optics Plastic 9.95$
U 33 Capri Optics Plastic 9.95$
U 40 Capri Optics Plastic 9.95$
U 208 Capri Optics Plastic 9.95$
US 53 Capri Optics Plastic 9.95$
US 55 Capri Optics Plastic 9.95$
US 74 Capri Optics Plastic 9.95$
US 78 Capri Optics Plastic 9.95$
Windy Modern Optical Plastic 9.95$
Yippee Modern Optical Plastic 9.95$
Yoni Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 18 of 83 Pages
Boys Frame List
Style Manufacturer Material Price
7716 Capri Optics Metal 9.95$
7725 Capri Optics Metal 9.95$
7731 Capri Optics Metal 9.95$
5th Avenue Limited Editions Metal 9.95$
Aries Modern Optical Metal 9.95$
Bicycle Modern Optical Plastic 9.95$
Cambridge Zimco Optics Plastic 9.95$
Climb Modern Optical Plastic 9.95$
Goodies Modern Optical Plastic 9.95$
Hide & Seek Modern Optical Metal; Plastic
Temples 9.95$
Incognito Modern Optical Plastic 9.95$
Kensington Capri Optics Metal 9.95$
LTD181 Limited Editions Metal 9.95$
Ninja Modern Optical Metal 9.95$
Rigid Modern Optical Plastic 9.95$
S-512 Zimco Optics Metal 9.95$
Shock Modern Optical Plastic 9.95$
Skippy Modern Optical Plastic 9.95$
Speckle Modern Optical Plastic 9.95$
Spunky Modern Optical Plastic 9.95$
Tackle Modern Optical Plastic 9.95$
Takeoff Modern Optical Plastic 9.95$
US 78 Capri Optics Plastic 9.95$
Yippee Modern Optical Plastic 9.95$
Yoni Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 19 of 83 Pages
Unisex Frame List
Style Manufacturer Material Price
7710 Capri Optics Metal 9.95$
7712 Capri Optics Metal 9.95$
Agree Modern Optical Plastic 9.95$
Answer Modern Optical Plastic 9.95$
Banzai Modern Optical Metal 9.95$
CC61 Zimco Optics Plastic 9.95$
Capricorn Modern Optical Metal 9.95$
Care Modern Optical Plastic 9.95$
Cheerful Modern Optical Metal 9.95$
Chelsea Zimco Optics Metal 9.95$
Chill Modern Optical Plastic 9.95$
Chris Modern Optical Plastic 9.95$
Cosmo Modern Optical Plastic 9.95$
CT 436 Limited Editions Metal 9.95$
Cyclone Modern Optical Metal 9.95$
Dynamite Modern Optical Metal 9.95$
EQ301 EyeQ Plastic 9.95$
EQ313 EyeQ Plastic 9.95$
Equal Modern Optical Plastic 9.95$
Falcon Modern Optical Plastic 9.95$
Finale Modern Optical Metal 9.95$
Gemini Modern Optical Metal 9.95$
Genius Modern Optical Plastic 9.95$
Harper Modern Optical Plastic 9.95$
Hudson Zimco Optics Metal 9.95$
Incognito Modern Optical Plastic 9.95$
Jazz Modern Optical Metal 9.95$
Keynote Modern Optical Metal 9.95$
L8001 Lantis Metal 9.95$
L8002 Lantis Plastic 9.95$
L8003 Lantis Metal 9.95$
L8004 Lantis Metal 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 20 of 83 Pages
Unisex Frame List
Style Manufacturer Material Price
L8005 Lantis Metal 9.95$
L8006 Lantis Plastic 9.95$
L8007 Lantis Plastic 9.95$
L8008 Lantis Metal 9.95$
L8009 Lantis Metal 9.95$
L8010 Lantis Metal 9.95$
L8011 Lantis Metal 9.95$
L8012 Lantis Metal 9.95$
L8013 Lantis Plastic 9.95$
L8014 Lantis Plastic 9.95$
L8015 Lantis Plastic 9.95$
L8016 Lantis Plastic 9.95$
L8017 Lantis Plastic 9.95$
L8018 Lantis Plastic 9.95$
L8019 Lantis Plastic 9.95$
L8020 Lantis Plastic 9.95$
L8021 Lantis Metal 9.95$
L8022 Lantis Metal 9.95$
L8023 Lantis Metal 9.95$
L8024 Lantis Metal 9.95$
L8026 Lantis Plastic 9.95$
L8027 Lantis Plastic 9.95$
L8028 Lantis Plastic 9.95$
L8029 Lantis Plastic 9.95$
L8030 Lantis Plastic 9.95$
Launch Modern Optical Plastic 9.95$
Looking Glass 1050 Hart Specialties Plastic 9.95$
Lollipop - Cable Modern Optical Metal 9.95$
Lollipop - Skull Modern Optical Metal 9.95$
Mainstreet 415 Hart Specialties Plastic 9.95$
Neon Modern Optical Plastic 9.95$
Now Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 21 of 83 Pages
Unisex Frame List
Style Manufacturer Material Price
Parallel Modern Optical Plastic 9.95$
Precise Modern Optical Plastic 9.95$
PT 61 Capri Optics Metal 9.95$
PT 62 Capri Optics Metal 9.95$
PT 84 Capri Optics Metal 9.95$
PT 87 Capri Optics Metal 9.95$
PT 89 Capri Optics Metal 9.95$
S-323 Zimco Optics Plastic 9.95$
S-325 Zimco Optics Plastic 9.95$
Score Modern Optical Plastic 9.95$
Sky Modern Optical Plastic 9.95$
Slick Modern Optical Plastic 9.95$
Slide Modern Optical Metal 9.95$
Smart Modern Optical Metal 9.95$
Sneakers Modern Optical Plastic 9.95$
Special Modern Optical Metal 9.95$
Splash Modern Optical Plastic 9.95$
Sporty Modern Optical Plastic 9.95$
Storm Modern Optical Plastic 9.95$
Structure Modern Optical Plastic 9.95$
Studio Modern Optical Metal 9.95$
SW444 EyeQ Plastic 9.95$
Tackle Modern Optical Plastic 9.95$
Tender Modern Optical Plastic 9.95$
Theory Modern Optical Plastic 9.95$
Tie Dye Modern Optical Plastic 9.95$
Todd Modern Optical Metal 9.95$
Tomorrow Modern Optical Plastic 9.95$
U 21 Capri Optics Plastic 9.95$
U 23 Capri Optics Plastic 9.95$
U 36 Capri Optics Plastic 9.95$
U 39 Capri Optics Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 22 of 83 Pages
Unisex Frame List
Style Manufacturer Material Price
UM 70 Capri Optics Plastic 9.95$
Urban Modern Optical Plastic 9.95$
US 56 Limited Editions Plastic 9.95$
US 75 Capri Optics Plastic 9.95$
Vibe Modern Optical Plastic 9.95$
Whimsy Modern Optical Metal 9.95$
Wiggle Modern Optical Plastic 9.95$
Yippee Modern Optical Plastic 9.95$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 23 of 83 Pages
Special Needs Frame List
ALL FRAMES LISTED REQUIRE PRIOR AUTHORIZATION
Style Manufacturer Material Price
Baby Lux Miraflex Rubber 40.00$
Baby Lux2 Miraflex Rubber 40.00$
Baby One 37 Miraflex Rubber 40.00$
Baby One 44 Miraflex Rubber 40.00$
Baby Plus Miraflex Rubber 40.00$
Baby Plus 2 Miraflex Rubber 40.00$
Baby Zero Miraflex Rubber 40.00$
Baby Zero 2 Miraflex Rubber 40.00$
Beginner Modern Optical Plastic 40.00$
Brian Capri Optics TR 90 40.00$
Eva Miraflex Rubber 40.00$
FX1 Capri Optics Titanium Memory Metal 40.00$
FX3 Capri Optics Titanium Memory Metal 40.00$
FX4 Capri Optics Titanium Memory Metal 40.00$
FX6 Capri Optics Titanium Memory Metal 40.00$
FX8 Capri Optics Titanium Memory Metal 40.00$
FX10 Capri Optics Titanium Memory Metal 40.00$
FX13 Capri Optics Titanium Memory Metal 40.00$
FX15 Capri Optics Titanium Memory Metal 40.00$
FX20 Capri Optics Titanium Memory Metal 40.00$
FX22 Capri Optics Titanium Memory Metal 40.00$
FX27 Capri Optics Titanium Memory Metal 40.00$
FX28 Capri Optics Titanium Memory Metal 40.00$
FX29 Capri Optics Titanium Memory Metal 40.00$
FX30 Capri Optics Titanium Memory Metal 40.00$
FX32 Capri Optics Titanium Memory Metal 40.00$
FX33 Capri Optics Titanium Memory Metal 40.00$
FX34 Capri Optics Titanium Memory Metal 40.00$
Maxi Baby Miraflex Rubber 40.00$
Maxi Baby 2 Miraflex Rubber 40.00$
Mini Baby Miraflex Rubber 40.00$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 24 of 83 Pages
Special Needs Frame List
ALL FRAMES LISTED REQUIRE PRIOR AUTHORIZATION
Style Manufacturer Material Price
New Baby 1 Miraflex Rubber 40.00$
New Baby 2 Miraflex Rubber 40.00$
New Baby 3 Miraflex Rubber 40.00$
New Baby 4 Miraflex Rubber 40.00$
Nick 50 Miraflex Rubber 40.00$
Nick 53 Miraflex Rubber 40.00$
Nicki 48 Miraflex Rubber 40.00$
Split A Capri Optics TR 90 40.00$
Split C Capri Optics TR 90 40.00$
T 18 Capri Optics TR 90 40.00$
T 28 Capri Optics TR 90 40.00$
T 30 Capri Optics TR 90 40.00$
Youth Capri Optics TR 90 40.00$
Model 1 Specs4us Titanium 40.00$
Model 2 Specs4us Titanium 40.00$
Model 3 Specs4us Titanium 40.00$
Model 4 Specs4us Titanium 40.00$
Model 5 Specs4us Titanium 40.00$
Model 6 Specs4us Titanium 40.00$
Model 7 Specs4us Titanium 40.00$
Model 8 Specs4us Titanium 40.00$
Model 9 Specs4us Titanium 40.00$
Model 11 Specs4us Titanium 40.00$
Model 12 Specs4us Titanium 40.00$
Model 13 Specs4us Titanium 40.00$
Model 14 Specs4us Titanium 40.00$
Model 15 Specs4us Titanium 40.00$
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 25 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
7710 Capri Optics Burgundy
Coffee
50-18-1440 Ink
B: 29.6
7712 Capri Optics Black
Coffee
47-20-140 Gunmetal
B: 25.9
7716 Capri Optics Black
Coffee
46-20-135 Plum
7719 Capri Optics Black
Coffee
54-19-145 Gunmetal
56-19-145
60-19-150
B: 31.2, 33.2,37
7725 Capri Optics Black
Burgundy
46-19-135 Coffee
7726 Capri Optics Black
Brown
50-18-140 Gunmetal
7731 Capri Optics Blue
Green
42-18-135
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 26 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
5th Avenue Limited Editions Mocha Marble
Tortoise
47-17-140 Black
Blush
14th Avenue Limited Editions Black
Burgundy
48-16-135 Grey
B: 23 Tortoise
Active Modern Optical Black
Burgundy
51-16-140 Tortoise
Adam Modern Optical Black
Brown
51-16-140 Grey
53-16-145
B: 38, 40
Adorable Modern Optical Black/Blue
Black/Brown
47-15-135 Black/Plum
Agree Modern Optical Black/Silver
Brown/Gold
52-16-140 Burgundy/Silver
B: 27
Amber Modern Optical Black/Crystal
Purple/Lilac
51-16-140 Teal/Crystal
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 27 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Anne Modern Optical Black/Burgundy
Brown
48-17-135 Dark Blue/Lt Blue
50-17-140
B: 30, 32
Answer Modern Optical Black
Blue
52-15-140 Brown
B: 28
Appeal Modern Optical Blue/Purple
Grey/Blue
51-20-140 Tortoise/Burgundy
Aries Modern Optical
Brown
48-20-140 Gold
50-20-145 Gunmetal
B: 28, 30
Attitude 18 Zimco Optics Black
Blue
49-17-135 Cranberry
B: 23
Banzai Modern Optical Blue
Brown
47-19-135 Matte Black
B:
Bashful Modern Optical Black/Crystal
Blue/Rose
42-16-130 Burgundy/Blue
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 28 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Beth Modern Optical Antique Silver
Gold
50-18-135 Matte Brown
52-18-140 Rose
B: 32.3, 34.3
Bicycle Modern Optical Black Matte
Navy Matte
45-15-130 Purple Matte
47-15-135
Boulevard 4154 Hart Specialties Brown
Gold
47-18-135 Silver
50-18-140
Brave Modern Optical Black
Blue
50-15-135 Brown
52-15-140
B: 24.6, 25.4
Bria Modern Optical Brown
Lilac
53-16-135 Rose
B: 30
Buzz Modern Optical Black
Tortoise
54-16-145
Cambridge Zimco Optics Amber
Black
47-19-140 Brown
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 29 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Camille Modern Optical Gunmetal
Light Brown
51-19-135 Rose
B: 34
Candia Limited Editions Black
Brown
50-17-130 Plum
52-17-135
Capricorn Modern Optical Matte Black
Matte Brown
47-20-135 Matte Silver
49-20-140
B: 23, 25
Care Modern Optical Black/Crystal
Navy/Crystal
42-15-125 Pink/Crystal
44-15-130 Purple/Crystal
46-15-135
B: 25, 27, 28
Caribbean Zimco Optics Gold
Matte Brown
51-19-140 Gunmetal
B: 28.8
Carousel Modern Optical Blue
Brown
43-17-125 Burgundy
45-17-130
B: 29, 31
Catchy Modern Optical Black
Brown
50-17-140 Burgundy
52-17-145
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 30 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
CC61 Zimco Optics Black Crystal
Brown
49-17-140 Light Gray
B: 25.4
Certain Modern Optical Black/Lime
Brown
48-18-130 Burgundy
50-18-135
B: 24.8, 26.8
Cheerful Modern Optical Black
Brown
40-18-120 Demi Amber
42-18-125 Gold
44-18-130 Pink
B: 24.6, 26.2, 28.9
Chelsea Zimco Optics Gold
Gunmetal
48-18-135 Matte Brown
B: 27
Chill Modern Optical Black/Blue
Black/Lilac
51-17-140 Black/Lime
B: 33 Black/Orange
Black/Pink
Black/Purple
Black/Red
Black/White
Black/Turquoise
Chris Modern Optical Blonde
Demi Amber
50-20-140 Grey
52-20-145
B: 41, 43
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 31 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Climb Modern Optical Black/Aqua Matte
Black/Lime Matte
45-16-130 Black/Red Matte
Clout Modern Optical Black
Brown
53-16-145 Grey
B: 32.4
Clutch Modern Optical Brown Fade
Grey Fade
52-18-140
Compliment Modern Optical Navy Blue Fade
Purple Fade
53-16-135 Wine Fade
Concert Modern Optical Black/Red
Black/White
53-18-135 Brown/Caramel
Confetti Modern Optical Blue
Fuschia
45-16-125 Teal
Connie Modern Optical Brown
Grey
50-17-135 Rose
52-17-140
B: 34, 36
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 32 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Cosmo Modern Optical Black
Brown Fade
48-20-145 Grey Fade
50-20-150
50-22-150
52-22-150
52-24-150
54-22-150
54-24-150
B: 36, 38, 40, 42
CT 436 Limited Editions Brown
Gold
44-18-125 Lilac
B: 25.6
CT 2294 Limited Editions Brown
Latte
50-18-140 Wine
B: 31.2
Curly Limited Editions Rose
Brown
36-18-130 Blue
38-18-135
40-18-140
B: 20, 21, 23
* Cannot be engraved due to small temple size
Cutie Modern Optical Antique Purple
DA/ Ant. Brown
32-15-115 Gold
35-15-120
B: 24.8, 26.5
Cyclone Modern Optical Brown
Gunmetal
50-19-140 Navy
B: 25
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 33 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Dance Modern Optical Black/Aqua
Black/Lilac
53-16-140 Tortoise
B: 33
Dawn Modern Optical Brown
Pink
41-16-120 Purple
43-16-125
45-16-130
B: 32, 34, 36
Dazzle Modern Optical Brown
Gold
49-20-135 Rose
51-20-140
53-20-145
B: 29, 31, 33
Degree Modern Optical Black
Tortoise
51-17-135
Diana Modern Optical Brown
Lilac
52-18-135 Rose
B: 37
Doug Modern Optical Antique Silver
Gold
52-20-140 Matte Brown
54-20-145
56-20-145
B: 39, 41, 43
Dynamite Modern Optical Antique Brown
Black
42-18-130 Silver
45-18-135
47-18-140
B: 26, 29, 31
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 34 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Eileen Modern Optical Black/Crystal
Brown/Crystal
56-17-140 Burgundy/Pink
B: 32.6
Emma Modern Optical Black/White
Blue
51-18-140 Brown/Beige
B: 23.5
EQ301 EyeQ Black
Tortoise
52-17-140
B: 34.2
EQ313 EyeQ Black
Purple
52-16-140
B: 38
Equal Modern Optical Black/Grey
Black/Pink
50-19-140 Black/Purple
B: 37 Black/Red
Black Matte
Ethel Modern Optical Black/Silver
Demi Amber/
49-18-135 Antique Brown
52-18-140 Matte Gold
55-18-140
B: 37, 40, 43
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 35 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Exclusive 119 Continental Brown
Optical Gold
55-16-140 Gunmetal
57-16-145
Exclusive 120 Continental Brown
Optical Matte Gold
53-18-140 Silver
55-18-145
B: 35, 38.5
Exclusive 157 Continental Brown
Optical Gunmetal
51-19-140 Matte Black
Falcon Modern Optical Black
Brown
47-20-140 Crystal
B: 31 Demi Amber
Feline Modern Optical Black
Brown
51-19-140 Teal
B: 32
Finale Modern Optical Antique Brown
Antique Silver
48-19-135 Gold
50-19-140
52-19-145
B: 26.7, 27.6, 30.6
Finesse Modern Optical Brown
Matte Black
49-17-135 Rose
B: 32
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 36 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Floral Modern Optical Brown/Black
Burgundy/Black
51-17-140 Purple/Black
Forbidden Modern Optical Black
Tortoise
48-18-140 Wine
Freedom Modern Optical Black/Blue
Black/Burgundy
50-16-140 Black/Frost
Fregossi 368 Continental Black
Optical Aqua
50-18-135 Sunset
B: 26.5
Gemini Modern Optical Blue
Brown
47-18-135 Matte Black
B: 27
Genius Modern Optical Black/Crystal
Burgundy/Crystal
47-21-140 Tortoise/Crystal
B: 37.2
Gift Modern Optical Black/Crystal
Brown/Crystal
47-17-135 Purple/Brown
49-17-140
B: 24.3, 26.3
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 37 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Glenn Modern Optical Matte Black
Matte Brown
53-18-140 Matte Gunmetal
55-18-145
B: 36, 38
Gloria Modern Optical Brown
Rose
54-20-140 Violet
56-20-145
B: 33, 34
Goodies Modern Optical Black/Blue
Black/Fuchsia
45-16-130 Black/Lime
Hannah Modern Optical Black/White
Brown
51-16-140 Burgundy/Black
B: 28.4
Harper Modern Optical Blue/Purple
Grey/Blue
50-19-140 Tortoise/Burgundy
B: 34
Heat Modern Optical Black
Brown
50-20-140 Gunmetal
B: 27
Hector Modern Optical Black
Brown
51-18-140
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 38 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Helen Modern Optical Brown
Rose
51-15-135 Violet
53-15-140
B: 31.5, 33.5
Hide & Seek Modern Optical Brown
Navy
42-19-125 Purple
44-19-143
B: 25, 27
Holiday Modern Optical Black
Purple
54-17-140 Red
Hudson Zimco Optics Gold
Brown
47-20-140 Gunmetal
B: 27.4
Icon Modern Optical Antique Silver
Black
51-19-135 Matte Brown
53-19-140 Satin Gold
B: 31.6, 33.6
Incognitio Modern Optical Black Matte
Blue Matte
47-18-135 Tortoise Matte
B: 34
Ivy Capri Optics Black
Gold
54-18-135 Gunmetal
56-18-140
58-18-145
B: 37.7, 39.8, 45.8
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 39 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
J5602 Hart Specialties Shiny Brown
Shiny Gold
41-19-125 Shiny Lilac
43-19-130
45-19-135
B: 28.4, 30.4, 32.4
* Cannot be engraved due to small temple size
James Modern Optical Coffee
Gold
56-17-140 Gunmetal
58-17-145
60-17-150
B: 45, 47, 49
Jazz Modern Optical Black
Brown
52-18-140 Gunmetal
54-18-145
56-18-150
58-18-155
B: 27, 29, 31, 33
Joseph Modern Optical Black
Matte Brown
54-19-140 Silver
56-19-145
58-19-150
B: 38, 40, 41
Judi Modern Optical Black/Crystal
Tortoise
50-16-135 Wine/Grey
53-16-140
B: 26, 28
Karma Modern Optical Black
Brown
55-16-140 Lavender
B: 30.4
Not recommended for powers over + 3.00
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 40 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Keith Modern Optical Antique Silver
Gold
54-16-140 Matte Brown
56-16-145
58-16-150
Kensington Capri Optics Black
Brown
45-19-135 Gunmetal
47-19-140
B: 25.9
Keynote Zimco Optics Matte Black
Matte Brown
51-17-135 Matte Plum
B: 26
Kiwi Capri Optics Ink
Pink
39-18-125 Coffee
41-18-130
B: 23.5, 25.8
Kody Modern Optical Black
Brown
52-18-140 Gunmetal
54-18-145
B: 34.3, 36.3
L6001 Lantis Wine Crystal
Black/Crystal
52-16-130 Purple/Crystal
54-16-135
B: 27, 29
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 41 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L6002 Lantis Blk/Honey Crystal
Brown Crystal
52-14-130 Dark Plum Crystal
B: 27
L6003 Lantis Purple/Crystal
Black/Crystal
52-16-130 Brown/Crystal
54-16-135
B: 30, 31
L6004 Lantis Black/Magenta
Black/Honey
50-16-138 Wine Crystal
52-16-135
B: 26, 29
L6005 Lantis Shiny Wine
Satin Brown
51-19-130 Shiny Black
B: 32
L6006 Lantis Satin Brown
Satin Plum
52-18-135 Shiny Wine
B: 33
L6007 Lantis Shiny Wine
Satin Gold
53-18-138 Satin Brown
B: 32
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 42 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L6008 Lantis Pink/Crystal
Brown/Crystal
51-17-130 Rose/Crystal
B: 39
L6009 Lantis Satin Brown
Shiny Wine
48-18-125 Satin Gold/Brown
B: 25
L6010 Lantis Satin Brown
Satin Black
49-16-130 Satin Silver
B: 30
L6011 Lantis Satin Pink
Satin Brown
50-18-130 Satin Plum
B: 33
L6012 Lantis Satin Plum
Satin Brown
49-18-130 Shiny Wine
B: 29
L6016 Lantis Lavender
Black
53-17-135 Tortoise
B: 34
L6017 Lantis Black
Brown
52-16-135 Purple
B: 35
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 43 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L6018 Lantis Burgundy
Black
52-17-145 Lavender
B: 38
L7001 Lantis Matte Black
Satin Brown
54-18-138 Satin Gold/Brown
B: 34
L7002 Lantis Shiny Black
Charcoal Crystal
53-16-138 Brown/Crystal
55-16-140
B: 29, 32
L7003 Lantis Satin Brown
Matte Black
52-19-140 Satin Gunmetal
B: 30
L7004 Lantis Satin Gunmetal
Satin Brown
52-18-135 Matte Black
B: 37
L7005 Lantis Satin Gunmetal
Satin Gold
50-19-135 Satin Brown
B: 29
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 44 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L7006 Lantis Black/Crystal
Brown Crystal
55-17-140 Tortoise
57-17-145
B: 31, 34
L7007 Lantis Shiny Black
Brown Crystal
53-15-145 Tortoise
55-17-145
B: 29, 34
L7008 Lantis Brown Crystal
Black/Crystal
53-17-135 Tortoise
B: 23
L7009 Lantis Satin Brown
Dark Gunmetal
58-19-150 Satin Gold
B: 44
L7010 Lantis Matte Black
Satin Gunmetal
54-20-140 Satin Gold
B: 37
L7011 Lantis Satin Dark Brown
Satin Gunmetal
54-18-145 Matte Black
B: 34
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 45 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L7012 Lantis Satin Gunmetal
Satin Brown
51-18-135 Matte Black
B: 29
L7015 Lantis Black
Gray
52-18-140 Navy
B: 36
"Cold Insert"
L7016 Lantis Gray
Black
55-15-140 Tortoise
B: 32
L7017 Lantis Gray
Matte Black
52-17-145 Tortoise
B: 38
L8001 Lantis Satin Brown
Satin Gunmetal
44-18-125 Satin Navy
B: 27
L8002 Lantis Black/Crystal
Brown/Crystal
46-15-125 Purple/Pink Crystal
B: 22
L8003 Lantis Matte Black/Navy
Satin Brown
48-17-135 Satin Gunmetal/Blk
B: 25
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 46 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L8004 Lantis Satin Pink
Satin Brown
47-17-130 Satin Gunmetal/Blk
B: 23
L8005 Lantis Satin Light Brown
36-17-140
38-17-140
40-18-140
B: 28
L8006 Lantis Navy/Crystal
Brown/Crystal
45-15-128 Black/Crystal
B: 26
L8007 Lantis Black/Crystal
Brown/Crystal
47-16-130 Red/Crystal
49-16-130
B: 24, 25
L8008 Lantis Satin Gunmetal
Satin Slate Blue
44-19-130 Satin Brown
B: 26
L8009 Lantis Satin Light Plum
Satin Gunmetal/Blk
46-18-130 Satin Brown
B: 26
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 47 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L8010 Lantis Satin Pink
Satin Red
45-19-125 Satin Brown
B: 27
L8011 Lantis Slate Blue
Satin Brown
42-18-120 Satin Light Plum
B: 25
L8012 Lantis Satin Brown
Satin Pink
46-18-125 Slate Blue
B: 27
L8013 Lantis Brown/Crystal
Black/Crystal
47-16-130 Blue/Crystal
B: 23
L8014 Lantis Blk/Magenta Crystal
Purple/Pink Crystal
48-16-130 Blk/Green Crystal
50-16-130
B: 25
L8015 Lantis Teal/Crystal
Purple/Crystal
45-17-126 Pink/Crystal
B: 26
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 48 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L8016 Lantis Black/Green Crystal
Brown/Crystal
45-16-127 Red/Crystal
B: 22
L8017 Lantis Purple Crystal
Black
46-17-130 Magenta Crystal
B: 24
L8018 Lantis Teal Blue Crystal
Pink Crystal
42-16-128 Black
45-16-130
B: 26
L8019 Lantis Purple Crystal
Navy Crystal
45-13-128 Brown Crystal
B: 27
L8020 Lantis Black
Brown Crystal
46-16-135 Navy Crystal
48-14-128
B: 27
L8021 Lantis Satin Gunmetal/Navy
Matte Black
50-17-130 Satin Brown
B: 24
L8022 Lantis Satin Navy
Satin Gunmetal/Blk
47-15-130 Satin Brown
B: 27
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 49 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
L8023 Lantis Satin Magenta
Satin Purple
48-16-135 Satin Brown
B: 27
L8024 Lantis Satin Black/Purple
Satin Brown
48-16-130 Satin Plum
B: 26
L8026 Lantis Black
Navy
48-15-130 Tortoise
B: 32
L8027 Lantis Rose
Black
46-15-130 Red
B: 29
L8028 Lantis Red
Black
48-17-130 Teal
B: 28
L8029 Lantis Black
Navy
46-17-130 Tortoise
B: 31
L8030 Lantis Navy
Black
44-16-125 Tortoise
B: 29
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 50 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Launch Modern Optical Black/Grey
Black/Red
51-18-140 Black/White
B: 30
LG1050 Hart Specialties Black
Brown
48-20-145
50-20/22-150
52-20/22/24-150
54-20/22/24-150
56-22/24-150
B: 35, 36, 38.5
40.5, 42.5
Lilac Capri Optics Coffee
Demi Amber
49-18-130 Gold/Silver
51-18-135
B: 32.6, 34.1
Lisa Modern Optical Brown
Rose
52-17-135 Violet
55-17-140
B: 38, 40
Liz Zimco Optics Brown
Demi Amber
53-16-140 Matte Gold
B: 36
Lollipop - Cable Modern Optical Amber
Brown
39-20-130 Rose
41-20-135
43-20-140
B: 30, 32, 34
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 51 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Lollipop - Skull Modern Optical Amber
Brown
39-20-120 Rose
41-20-125
43-20-130
43-20-125
B: 30, 32, 34
LTD 181 Limited Editions Brown
Demi Amber
43-20-130 Pink
46-20-135
49-20-140
52-20-145
Lulu Modern Optical Black/Rose
Black/Violet
50-16-135 Brown
B: 26.9
Mainstreet 415 Hart Specialties Light Blue
Light Brown
33-20-115 Pink
36-20-120
39-20-125
B: 29.2, 32.2, 35.2
Manhattan Limited Editions Blue Crystal
Brown Crystal
50-17-140 Rose Crystal
Media Modern Optical Black/Blue
Black/Brown
54-16-140 Black/Burgundy
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 52 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Metropolitan Modern Optical Black Matte
Crystal
53-18-150 Tortoise
Mingle Modern Optical Black
Brown
53-18-135 Burgundy
B: 29.5
Monaco Zimco Optics Brown
Gold
48-18-140 Gunmetal
Monica Modern Optical Brown
Grey
50-17-130 Rose
52-17-135
54-17-140
B: 39.2, 41.2, 43.2
Moscow Zimco Optics Gold
Gunmetal
54-16-140 Demi Amber
56-18-145
58-18-150
B: 42, 43, 44.5
Nancy Modern Optical Antique Brown
Gold
52-18-135 Silver
B: 37
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 53 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Natalie Modern Optical Amethyst
Brown
50-18-135 Demi Amber
52-18-140
54-18-145
Neon Modern Optical Blue
Brown
45-19-140 Burgundy
B: 29
Ninja Modern Optical Matte Black
Matte Brown
44-18-130 Matte Blue
46-18-135 Matte Burgundy
B: 23.4, 24.4 Violet
Now Modern Optical Black/Rose
Blue/Pink
53-15-140 Brown
B: 29
Overview Modern Optical Amethyst
Black
50-22-145 Brown
B: 28 Grey
Purple
Pacific Zimco Optics Brown
Matte Gunmetal
53-18-135 Shiny Gold
Parallel Modern Optical Blue Fade
Burgundy Fade
53-20-145 Grey Fade
B: 35
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 54 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Patches Modern Optical Black/Crystal
Navy/Crysal
45-18-130 Purple/Crystal
Patience Modern Optical Black/Tortoise Matte
Blue Matte
54-14-140 Plum Matte
Phase Modern Optical Blue
Burgundy
52-17-145 Teal
Pixie Modern Optical Brown/Crystal
Black/Crystal
48-16-130 Plum/Crystal
B: 25
Plasma Modern Optical Black
Brown
51-16-140 Navy
53-16-145
B: 27, 27.9
Pleasure Modern Optical Black
Teal/Crystal
52-18-140 Tortoise
Precise Modern Optical Black/Crystal
Grey
51-18-140 Red
B: 34
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 55 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
PT 36 Capri Optics Antique Brown
Black
52-18-135 Gunmetal
54-18-140
B: 38, 39.4
PT 48 Capri Optics Black Gold
Gold
54-19-140 Gunmetal
56-19-145
60-19-150
B: 37.8, 39.4, 42.2
PT 56 Capri Optics Coffee
Gold
53-16-140 Gunmetal
55-16-145
B: 39.7, 41.4
PT 61 Capri Optics Coffee
Gold
46-19-140
48-19-145
B: 31, 31.8
PT 62 Capri Optics Burgundy
Coffee
45-19-135 Silver
47-19-140
B: 23.8, 25.8
PT 67 Capri Optics Burgundy
Coffee
44-16-125 Denim
B: 23.4
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 56 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
PT 79 Capri Optics Antique Pewter
Black
47-19-135 Brown
49-19-140
B: 22.4, 26.8
PT 80 Capri Optics Antique Pewter
Brown
51-18-135 Plum
53-18-140
B: 29.6, 32.4
PT 84 Capri Optics Brown
Black
42-17-125 Blue
45-17-130
48-19-135
B: 22.8; 25.8; 28.8
PT 85 Capri Optics Black
Brown
54-18-145 Gunmetal
56-18-150
B: 30.2; 32.2
PT 86 Capri Optics Brown
Burgundy
50-18-135 Purple
B: 25.8
PT 87 Capri Optics Black
Brown
49-18-135 Gunmetal
B: 24.4
PT 89 Capri Optics Brown
Black Blue
47-18-135
B: 23.8
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 57 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
PT 92 Capri Optics Black
Gunmetal
54-18-145 Brown
57-18-150
Pumpkin - Cable Modern Optical d.a./Antique Brown
Black
40-16-130 Blue
42-16-135 Gold
B: 26
Pumpkin - Skull Modern Optical d.a./Antique Brown
Black
40-16-120 Blue
42-16-125 Gold
B: 28
Ralph Modern Optical Black
Brown
52-17-140 Grey
54-17-145
56-17-150
B: 35.1, 37.1, 39.1
Randi Modern Optical Purple
Brown
44-16-125 Pink
46-16-130
B: 26, 28
Relax Modern Optical Black/Tortoise Matte
Plum Tortoise Matte
50-19-140 Teal/Tortoise Matte
Rigid Modern Optical Black
Blue
49-17-140 Brown
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 58 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Rori Modern Optical Black
Brown
50-17-135 Burgundy
B: 25
S-310 Zimco Optics Brown
Blue
52-16-140 Pink
S-313 Zimco Optics Blue
Pink/Grape
52-16-140 Violet
B: 27
S-323 Zimco Optics Brown
Grey
49-19-135
B: 25.8
S-325 Zimco Optics Black Crystal
Brown Crystal
48-20-140
B: 22.4
S-510 Zimco Optics Brown
Gunmetal
50-22-140 Matte Black
B: 32.4
S-512 Zimco Optics Shiny Brown
Shiny Burgundy
47-18-140 Shiny Gold
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 59 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Sadie Modern Optical Black
Brown
49-18-135 Burgundy
B: 25.8
Score Modern Optical Black
Tortoise
44-15-130
46-15-135
B: 26
Sheer Modern Optical Black/Blue
Black/Mint
51-15-140 Black/Violet
Shock Modern Optical Black
Brown/Blue
48-18-140 Tortoise
B: 21.6
Skippy Modern Optical Blue
Brown
44-16-125 Rose
46-16-130
Sky Modern Optical Black
Brown
47-17-130 Burgundy
49-17-135
B: 25.7, 27.7
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 60 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Slick Modern Optical Black
Tortoise
49-17-135 White
51-17-140 Red
54-17-145
57-17-150
60-17-150
B: 30, 32, 35, 37,39
Slide Modern Optical Matte Black
Matte Brown
48-20-135 Matte Burgundy
B: 27
Smart Modern Optical Black
Brown
45-20-135 Grey
B: 25
Sneakers Modern Optical Blonde
Brown Blue
42-18-125 Wine Grey
45-18-130
47-18-135
B: 25.9, 28.9, 30.9
Special Modern Optical Black
Brown
46-20-130 Violet
48-20-135
50-20-140
B: 27.4, 29.4, 31.4
Speckle Modern Optical Blue
Brown
44-17-130 Purple
46-17-135
B: 24.3, 26.3
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 61 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Splash Modern Optical Black-in-Line
Blue-in-Line
46-18-130 Brown-in-Line
48-18-135 Red-in-Line
B: 21.4, 23.4
Sporty Modern Optical Black/Crystal
Blue
44-17-125 Brown
46-17-130
B: 27, 29
Spunky Modern Optical Black/Navy
Black/Pink
47-16-130 Black/Red
Black/Sky Blue
Storm Modern Optical Black
Blonde
48-16-140 Blue
B: 30 Brown
Burgundy
Demi Amber
Structure Modern Optical Black
Brown
50-17-130 Navy
52-17-135
B: 26.6, 28.6
Studio Modern Optical Black
Brown
51-19-140 Gunmetal
B: 27
SW319 EyeQ Black Crystal
Plum
48-17-140 Tortoise
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 62 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
SW444 EyeQ Blue
Red
51-17-135
B: 34
SW445 EyeQ Purple
Tortoise
52-15-140
B:37
Swift Modern Optical Antique Brown
Black
50-19-140 Gold
52-19-145
B: 35, 37
Swirl Modern Optical Black
Brown
51-16-135 Burgundy
B: 26.8
Tackle Modern Optical Black
Navy
45-16-130 Tortoise
47-16-135
Tactic Modern Optical Matte Black
Matte Brown
53-18-140 Matte Gunmetal
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 63 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Taffy Modern Optical Brown
Burgundy
50-17-135 Violet
Takeoff Modern Optical Black/Blue
Black/Grey
47-17-135 Black/Hot Pink
49-17-140
Ted (CC Temple) Modern Optical Black
Brown
52-19-165CC Gunmetal
54-19-170CC
B: 32, 35
Tender Modern Optical Black/Teal
Purple
47-19-130 Teal/Black
B: 30
Theory Modern Optical Brown
Black
50-21-140
B: 36.8
Thrive Modern Optical Black
Brown
52-18-140
Tie Dye Modern Optical Tie-Dye Blue
Tie-Dye Brown
45-17-130 Tie-Dye Purple
47-17-135
B: 23.7, 25.7
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Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 64 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Tigress Modern Optical Black
Brown
52-16-140 Burgundy
B: 26.8
Todd Modern Optical Antique Brown
Antique Gold
46-18-135 Matte Black
48-18-140
50-18-145
B: 26, 28
Tomorrow Modern Optical Black
Brown
51-17-135 Grey
53-17-140
55-17-145
B: 24, 26, 28
Tori Modern Optical Black
Brown
44-15-130 Blue
46-15-135 Pink
B: 23.2, 25.2
Tornado Modern Optical Brown
Grey
52-18-140 Smoke
54-18-145
56-18-150
B: 45, 47, 49
U 10 Capri Optics Black Amber
Brown
48-18-140 Burgundy
B: 24.9
Effective 9/01/2017
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Frames
Name & Sizes Manufacturer Picture Colors
U 14 Capri Optics Grey Marble
Black Amber
48-18-140 Brown
B: 27.9
U 21 Capri Optics Black
Brown
50-18-145 Brown Blue
B: 27.5
U 23 Capri Optics Black Crystal
Brown
48-20-140 Grey Marble
B: 26.3
U 28 Capri Optics Black Crystal
Brown
48-18-140 Grey Marble
B: 27
U 31 Capri Optics Black Crystal
Brown
48-18-140 Burgundy
U 32 Capri Optics Black
Brown
50-19-140 Grey
B: 31
U 33 Capri Optics Black
Brown
50-15-140 Mauve
B: 26.6
Not recommended for powers over + 3.00
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 66 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
U 35 Capri Optics Brown
Burgundy
52-17-140
U 36 Capri Optics Black
Brown
52-18-140 Grey
B: 36
U 37 Capri Optics Black Amber
Brown
50-17-140 Burgundy
B: 25.5
U 39 Capri Optics Black
Brown
51-17-140 Grey
B: 30
U 40 Capri Optics Brown
Tortoise
48-18-140 Black Crystal
U 203 Capri Optics Black
Burgundy
49-18-135 Tortoise
52-18-140
U 205 Capri Optics Black
Brown
48-18-140 Tortoise
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 67 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
U 208 Capri Optics Purple
Brown
49-15-140 Black Wine
UL 90 Capri Optics Blue
Brown
51-18-135 Pink
UL 91 Capri Optics Brown
Pink
52-20-140
B: 36.2
UM 70 Capri Optics Black
Brown
52-22-140 Grey
54-22-145
B: 36.5, 39
UM 72 Capri Optics Brown
Grey
55-18-140
57-18-145
B: 49.4, 51.4
UM 73 Capri Optics Black
Brown
54-18-140 Grey
56-18-145
Unite Modern Optical Black
Crystal/Black
51-17-140 Tortoise
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 68 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Uptown Limited Editions Charcoal
Ebony
51-18-145 Mocha
Tortoise
Urban Modern Optical Black
Crystal
51-17-140 Navy/Tortoise
B: 33 Tortoise
US 50 Capri Optics Black Crystal
Brown
49-20-140 Grey Marble
B: 25.6
US 51 Capri Optics Brown Lavender
Black Crystal
48-16-135 Mauve
B: 23.9
US 53 Capri Optics Brown Crystal
Wine
51-19-140 Black Crystal
B: 25.8
US 54 Capri Optics Brown
Black
56-17-140 Wine
US 55 Capri Optics Brown
Pink
46-15-130 Purple
B: 24.4
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 69 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
US 56 Capri Optics Brown
Grey
51-18-135 Tortoise
B: 29.3
US 57 Capri Optics Black
Brown
50-17-140 Burgundy
B: 22
US 65 Capri Optics Black
Brown
44-14-125 Burgundy
47-14-135
B: 23.4, 24.2
US 67 Capri Optics Black
Brown
51-17-135 Tortoise
US 73 Capri Optics Black
Brown
53-18-145 Tortoise
55-18-150
US 74 Capri Optics Black
Brown
51-17-135 Purple
53-17-140 Wine
B: 36.4
US 75 Capri Optics Black
Grey
51-17-140 Tortoise
54-17-145
B: 33.8
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 70 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
US 78 Capri Optics Black
Brown
44-17-130 Blue
47-17-135 Red
US 80 Capri Optics Black
Brown
51-17-140 Tortoise
54-17-145
Vern Modern Optical Black
Brown
52-20-135 Gold
54-20-140
B: 30; 32
Vibe Modern Optical Black/Crystal
Blue
49-18-130 Brown
B: 26
Visa Modern Optical Black/Crystal
Brown/Crystal
54-17-140 Navy/Crystal
B: 32.2
Whimsy Modern Optical Black
Brown
43-17-120 Violet
45-17-125
B: 23, 25
Wiggle Modern Optical Black
Brown
40-16-120 Purple
42-16-125
44-16-130
B: 21.7, 23.7, 25.7
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 71 of 83 Pages
Frames
Name & Sizes Manufacturer Picture Colors
Windy Modern Optical Black/Crystal
Brown/Crystal
41-17-120 Violet/Crystal
43-17-125
B: 21.8, 23.8
Wow Modern Optical Black/Lime
Brown
49-16-135 Burgundy/Grey
51-16-140
Yippee Modern Optical Black/Grey Matte
Black/Hot Pink Matte
49-18-135 Black/Red Matte
B: 32
Yoni Modern Optical Antique Brown
Black
42-18-125 Gold
44-18-130
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 72 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Baby Lux Miraflex See Chart
38/12 Prior Authorization
Required
Baby Lux 2 Miraflex See Chart
40/14 Prior Authorization
Required
Baby One 37 Miraflex See Chart
37/14 Prior Authorization
Required
Baby One 44 Miraflex See Chart
44/16 Prior Authorization
Required
Baby Plus Miraflex See Chart
39/14 Prior Authorization
Required
Baby Plus 2 Miraflex See Chart
42/14 Prior Authorization
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 73 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Baby Zero Miraflex See Chart
31/15 Prior Authorization
Required
Baby Zero 2 Miraflex See Chart
34/15 Prior Authorization
Required
Beginner Modern Optical Pastel Blue
Pastel Brown
38-17-120 Prior Authorization Pastel Rose
40-17-125 Required
B: 17
Brian Capri Optics Black
Blue
53-18-140 Prior Authorization Brown
Required
Eva Miraflex See Chart
43/15 Prior Authorization
Required
FX1 Capri Optics Coffee
Ink
46-19-140 Prior Authorization Silver
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 74 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
FX3 Capri Optics Coffee
Gold
50-20-145 Prior Authorization Gunmetal
Required
FX4 Capri Optics Black
Coffee
48-20-145 Prior Authorization Silver
Required
FX6 Capri Optics Black
Coffee
53-20-145 Prior Authorization Gunmetal
Required
FX8 Capri Optics Coffee
Gold
53-19-145 Prior Authorization Silver
Required
FX10 Capri Optics Black
Coffee
55-17-145 Prior Authorization Gunmetal
Required
FX13 Capri Optics Coffee
Gold
52-20-145 Prior Authorization Gunmetal
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 75 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
FX15 Capri Optics Coffee
Gunmetal
47-19-140 Prior Authorization Denim
Required
FX20 Capri Optics Black
Coffee
52-17-140 Prior Authorization Gunmetal
Required
FX22 Capri Optics Black
Coffee
55-19-140 Prior Authorization Gunmetal
Required
FX27 Capri Optics Gold
Coffee
53-19-145 Prior Authorization Gunmetal
Required
FX28 Capri Optics Black
Coffee
52-18-145 Prior Authorization Gunmetal
Required
FX29 Capri Optics Black
Coffee
54-20-145 Prior Authorization Gunmetal
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 76 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
FX30 Capri Optics Gold
Coffee
54-18-140 Prior Authorization Gunmetal
Required
FX32 Capri Optics Black
Gunmetal
54-19-145 Prior Authorization Brown
Required
FX33 Capri Optics Coffee
Gunmetal
47-19-125 Prior Authorization Ink
Required
FX34 Capri Optics Coffee
Gunmetal
49-19-135 Prior Authorization Pink
Required
Maxi Baby Miraflex See Chart
38/12 Prior Authorization
Required
Maxi Baby 2 Miraflex See Chart
40/15 Prior Authorization
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 77 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Mini Baby Miraflex See Chart
33/11 Prior Authorization
Required
New Baby 1 Miraflex See Chart
39-14 Prior Authorization
Required
New Baby 2 Miraflex See Chart
42/14 Prior Authorization
Required
New Baby 3 Miraflex See Chart
45/17 Prior Authorization
Required
New Baby 4 Miraflex See Chart
47/17 Prior Authorization
Required
Nick 50 Miraflex See Chart
50/19 Prior Authorization
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 78 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Nick 53 Miraflex See Chart
53/19 Prior Authorization
Required
Nicki 48 Miraflex See Chart
48/15 Prior Authorization
48/18 Required
Split A Capri Optics Burgundy
Purple
47-17-140 Prior Authorization Blue/Black
Required
Split C Capri Optics Black
Tortoise
51-16-145 Prior Authorization Grey/Blue
Required
T 18 Capri Optics Brown
Black
44-17-125 Prior Authorization Pink
Required Purple
T 28 Capri Optics Black
Brown
42-15-125 Prior Authorization Blue
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 79 of 83 Pages
Special Needs FramesALL FRAMES LISTED REQUIRE A PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
T 30 Capri Optics Black
Brown
48-16-125 Prior Authorization Grey
Required
Youth Capri Optics Black
Brown
47-15-125 Prior Authorization Blue
Required
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 80 of 83 Pages
Special Needs FramesSpecs4us Frames are designed for individuals with Down Syndrome to fit their unique needs.Custom designed with shortened temples, extra wide frame fronts and a lowered bridge.ALL FRAMES LISTED REQUIRE PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Model 1 Specs4us Brown
Pink
35-16-105 Prior Authorization Navy
38-16-110 Required Violet
40-16-110
43-18-120
B: 20.2, 23.2, 25.2
Model 2 Specs4us Pink
Violet
40-16-110 Prior Authorization Wine
43-16-120 Required
46-18-125
B: 25.4, 28.4, 31.4
Model 3 Specs4us Blue Demi
Green Light
38-16-110 Prior Authorization Violet
40-16-110 Required
43-18-120 Eye Sizes 43 and 46
46-18-125 Blue Light
B: 22.2, 28.4, 30.2
Model 4 Specs4us Green Dark
Gunmetal Light
41-16-115 Prior Authorization Pink
43-16-120 Required Pink Demi
46-18-125 Navy
B: 22.5, 24.5, 27.5
Model 5 Specs4us Black Demi
Brown & Silver Matte
48-18-125 Prior Authorization Green Dark
51-18-125 Required Gunmetal Light
B: 28.2, 31.5
Model 6 Specs4us Eye Size 33
Brown
33-15-110 Prior Authorization Pink
35-16-105 Required
38-16-110 Eye Sizes 35 - 41
41-16-115 Blue Demi
Brown
B: 25, 25.4, 28.4, 30.5 Gunmetal Light
Pink
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 81 of 83 Pages
Special Needs FramesSpecs4us Frames are designed for individuals with Down Syndrome to fit their unique needs.Custom designed with shortened temples, extra wide frame fronts and a lowered bridge.ALL FRAMES LISTED REQUIRE PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Model 7 Specs4us Brown
Navy
42-16-120 Prior Authorization Red
45-16-120 Required Violet Dark
48-20-125
B: 25.8, 28.8
Model 8 Specs4us Brown
Brown & Silver Matte
43-16-120 Prior Authorization Gold Demi
46-18-125 Required Navy
B: 24.8, 27.8 Orange & Silver Matte
Model 9 Specs4us Eye Sizes 35 - 43
Green Dark
35-16-105 Gunmetal Dark
38-16-110 Prior Authorization Pink Demi
40-16-110 Required Wine
43-16-120
46-18-125 Eye Sizes 38 & 43
48-18-125 Navy
B: 28.4, 25.6, 28.5
B: 29.2, 28.2 Eye Sizes 46 - 48
Aqua
Pink Antique
Blue
Brown/Silver Matte
Model 11 Specs4us Blue Bright
Brown
38-16-105 Prior Authorization Black Shiny
40-16-120 Required Wine Matte
43-16-120
B: 20, 25, 26 Eye Size 43
Dark Violet
Model 12 Specs4us Black & Gun Dark Matte
Brown Med & Drk Brown
46-18-120 Prior Authorization Wine Matte
48-18-125 Required
B: 28, 29 Eye Size 46
Dark Violet
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 82 of 83 Pages
Special Needs FramesSpecs4us Frames are designed for individuals with Down Syndrome to fit their unique needs.Custom designed with shortened temples, extra wide frame fronts and a lowered bridge.ALL FRAMES LISTED REQUIRE PRIOR AUTHORIZATION
Name & Sizes Manufacturer Picture Colors
Model 13 Specs4us Brown Matte
43-20-120 Green Dark Matte
46-20-125 Prior Authorization Wine Matte
48-22-130 Required
51-22-130
B: 24, 25.5, 27
Model 14 Specs4us Brown & Silver Matte
43-18-120 Navy
46-20-125 Prior Authorization Violet
48-20-130 Required
B: 24, 26.5, 28
Model 15 Specs4us Eye Sizes 46 - 48
46-20-125 Brown & Lt. Orange
48-20-130 Prior Authorization Red/Pink
54-22-135 Required Navy & Lt. Blue
B: 23, 25, 27 Black & Lt. Gray
Eye Size 54
Brown & Lt. Orange
Black & Lt. Gray
Effective 9/01/2017
Revised 3/14/2018 Alabama Medicaid Frame Brochure Page 83 of 83 Pages
MIRAFLEX
Flexible & Safe Color
Baby Zero
31/15
Mini Baby
33/11
Baby
Zero2
34/15
BabyOne 37
37/14
Baby Lux
38/12
Maxi
Baby
38/12
Baby Plus
39/14
New
Baby1
39/14
Baby
Lux2
40/14
Maxi
Baby2
40/15
Baby Plus 2
42/14
New Baby2
42/14
Eva
43/15
Baby One 44
44/16
New Baby3
45/17
New Baby 4
47/17
Nicki
48/15
48/18
Nick 50
50/19
Nick 53
53/19
Reference BZ M1 BZ2 B1.37 MBL MB BP NB1 MBL2 MB2 BP2 NB2 EV B1.44 NB3 NB4 N48 N50 N53
B - Pink B B B B B B B B B B B B B B B B B
BC - Clear Pink BC BC BC BC BC BC BC BC BC BC BC BC BC BC BC BC BC
BCP - Clear Pink Pearl BCP BCP BCP BCP BCP BCP BCP BCP BCP BCP BCP
BP - Blush Pink BP BP BP BP
BS - Magenta BS BS BS BS BS BS
CP -Royal Blue CP CP CP CP CP CP CP CP CP CP CP
D- Dark Blue D D D D D D D D D D D D D D D D D D D
DP - Dark Blue Pearl DP DP DP DP DP DP DP DP DP DP DP DP DP DP DP DP DP DP DP
DS - Navy Blue DS DS DS DS DS DS DS DS DS DS DS DS DS DS DS DS DS DS
DV - Teal DV DV DV DV
E - Light Blue E E E E E E E E E
EC - Clear Blue EC EC EC EC EC EC EC EC EC EC EC EC EC EC EC EC
ECP - Clear Blue Pearl ECP
EP - Light Blue Pearl EP EP EP EP EP EP EP EP EP EP EP EP EP
FC - Clear Beige FC FC FC FC FC FC FC FC FC FC
HP - Yellow Pearl HP HP HP HP HP HP HP HP HP HP HP
HSP - Mustard
I - Red I I I I I I I I I I I
IN - Bright Orange IN IN IN IN
IP - Red Pearl IP IP IP IP IP IP IP IP IP IP IP IP IP IP IP IP
J - Dark Gray J J J J J J J J J J J J J J J J J J J
JC - Clear Gray JC JC JC JC JC JC JC JC JC JC JC JC JC JC JC JC JC JC JC
JS - Black JS JS JS JS JS JS JS JS JS JS
K - Burgundy K K K K K K K
KM - Burgundy Metallic KM KM KM KM KM KM KM KM KM KM
KP - Burgundy Pearl KP KP KP KP KP KP KP KP KP KP KP KP KP KP KP KP KP
L - Lavender L L L L L L L L L L L L L L L L L L
M - Milk Chocolate M M M M M M M M M M MM M M M M M
MM - Dark Brown MM MM MM MM MM MM MM MM MM MM MM MM MM MM
N - White N N N N N N N N N N N N N N N N N N
NC - White Glitter NC NC NC NC NC NC NC
OM - Indigo OM OM OM OM OM OM OM OM OM OM OM OM OM OM
P - Plum P P P P P P P P P P P P P P P P P
V - Green V V V
VC - Clear Green VC VC VC VC VC VC
VCP - Clear Green Pearl VCP VCP VCP VCP VCP
VM - Turquoise Green VM VM VM VM VM VM VM VM VM VM VM VM VM VM VM VM VM
VP - Green Pearl VP VP VP VP VP VP VP VP VP VP VP VP VP VP VP
VS - Hunter Green VS
Available Frame Color Revised 170811
Unavailable Frame Color