ForwardHealth Update 2011-40 - The Wisconsin Medicaid Electronic
Frame Brochure For Wisconsin Medicaid And BadgerCare Plus ... · Frame Brochure . For . Wisconsin...
57
Frame Brochure For Wisconsin Medicaid And BadgerCare Plus Members Effective December 1, 2016 Revised September 30, 2019 Classic Optical Laboratories, Inc. 3710 Belmont Avenue Youngstown, OH 44505 (888) 522-2020 FAX: (888) 522-2022 www.classicoptical.com
Transcript of Frame Brochure For Wisconsin Medicaid And BadgerCare Plus ... · Frame Brochure . For . Wisconsin...
Frame Brochure
For
Wisconsin Medicaid
And
BadgerCare Plus Members
Effective December 1, 2016 Revised September 30, 2019
Classic Optical Laboratories, Inc.
3710 Belmont Avenue Youngstown, OH 44505
(888) 522-2020 FAX: (888) 522-2022
www.classicoptical.com
Frame Additions
Frame Name Manufacturer Date
Baby One Miraflex 9/30/2019Baby One 2 Miraflex 9/30/2019Mayan 1 Miraflex 9/30/2019Mayan 2 Miraflex 9/30/2019Mayan 3 Miraflex 9/30/2019Model 16 Specs4Us 9/30/2019Nicki 50 Miraflex 9/30/2019Nicki 53 Miraflex 9/30/2019
L6016 Lantis 8/1/2017L6017 Lantis 8/1/2017L6018 Lantis 8/1/2017L7015 Lantis 8/1/2017L7016 Lantis 8/1/2017L7017 Lantis 8/1/2017L8026 Lantis 8/1/2017L8027 Lantis 8/1/2017L8028 Lantis 8/1/2017L8029 Lantis 8/1/2017L8030 Lantis 8/1/2017
Baby Lux Miraflex 12/1/2016Baby Lux 2 Miraflex 12/1/2016Baby One 37 Miraflex 12/1/2016Baby One 44 Miraflex 12/1/2016Baby Plus Miraflex 12/1/2016Baby Plus 2 Miraflex 12/1/2016Brave Modern Optical 12/1/2016Bria Modern Optical 12/1/2016Care Modern Optical 12/1/2016Chill Modern Optical 12/1/2016Cosmo Modern Optical 12/1/2016Eileen Modern Optical 12/1/2016Equal Modern Optical 12/1/2016Eva Miraflex 12/1/2016
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 1 of 55 Pages
Frame Additions
Frame Name Manufacturer Date
Exclusive 157 Continental Optical 12/1/2016Fregossi 368 Continental Optical 12/1/2016Jam’n Hilco 12/1/2016Karen Modern Optical 12/1/2016Kody Modern Optical 12/1/2016L6001 Lantis Optical 12/1/2016L6002 Lantis Optical 12/1/2016L6003 Lantis Optical 12/1/2016L6004 Lantis Optical 12/1/2016L6005 Lantis Optical 12/1/2016L6006 Lantis Optical 12/1/2016L6007 Lantis Optical 12/1/2016L6008 Lantis Optical 12/1/2016L6009 Lantis Optical 12/1/2016L6010 Lantis Optical 12/1/2016L6011 Lantis Optical 12/1/2016L6012 Lantis Optical 12/1/2016L7001 Lantis Optical 12/1/2016L7002 Lantis Optical 12/1/2016L7003 Lantis Optical 12/1/2016L7004 Lantis Optical 12/1/2016L7005 Lantis Optical 12/1/2016L7006 Lantis Optical 12/1/2016L7007 Lantis Optical 12/1/2016L7008 Lantis Optical 12/1/2016L7009 Lantis Optical 12/1/2016L7010 Lantis Optical 12/1/2016L7011 Lantis Optical 12/1/2016L7012 Lantis Optical 12/1/2016L8001 Lantis Optical 12/1/2016L8002 Lantis Optical 12/1/2016L8003 Lantis Optical 12/1/2016L8004 Lantis Optical 12/1/2016L8005 Lantis Optical 12/1/2016L8006 Lantis Optical 12/1/2016
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 2 of 55 Pages
Frame Additions
Frame Name Manufacturer Date
L8007 Lantis Optical 12/1/2016L8008 Lantis Optical 12/1/2016L8009 Lantis Optical 12/1/2016L8010 Lantis Optical 12/1/2016L8011 Lantis Optical 12/1/2016L8012 Lantis Optical 12/1/2016L8013 Lantis Optical 12/1/2016L8014 Lantis Optical 12/1/2016L8015 Lantis Optical 12/1/2016L8016 Lantis Optical 12/1/2016L8017 Lantis Optical 12/1/2016L8018 Lantis Optical 12/1/2016L8019 Lantis Optical 12/1/2016L8020 Lantis Optical 12/1/2016L8021 Lantis Optical 12/1/2016L8022 Lantis Optical 12/1/2016L8023 Lantis Optical 12/1/2016L8024 Lantis Optical 12/1/2016Launch Modern Optical 12/1/2016Lulu Modern Optical 12/1/2016Mainstreet 415 Hart Specialties 12/1/2016Maxi Baby Miraflex 12/1/2016Maxi Baby 2 Miraflex 12/1/2016Mini Baby Miraflex 12/1/2016Model 1 Specs4Us 12/1/2016Model 2 Specs4Us 12/1/2016Model 3 Specs4Us 12/1/2016Model 4 Specs4Us 12/1/2016Model 5 Specs4Us 12/1/2016Model 6 Specs4Us 12/1/2016Model 7 Specs4Us 12/1/2016Model 8 Specs4Us 12/1/2016Model 9 Specs4Us 12/1/2016Model 11 Specs4Us 12/1/2016Model 12 Specs4Us 12/1/2016
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 3 of 55 Pages
Frame Additions
Frame Name Manufacturer Date
Model 13 Specs4Us 12/1/2016Model 14 Specs4Us 12/1/2016Model 15 Specs4Us 12/1/2016New Baby 3 Miraflex 12/1/2016New Baby 4 Miraflex 12/1/2016Nick 50 Miraflex 12/1/2016Nick 53 Miraflex 12/1/2016Nicki 48 Miraflex 12/1/2016Parallel Modern Optical 12/1/2016Pixie Modern Optical 12/1/2016Precise Modern Optical 12/1/2016PT 61 Capri Optics 12/1/2016PT 84 Capri Optics 12/1/2016PT 85 Capri Optics 12/1/2016Sadie Modern Optical 12/1/2016Slick Modern Optical 12/1/2016Takeoff Modern Optical 12/1/2016Tomorrow Modern Optical 12/1/2016T-Zone Hilco 12/1/2016UM 70 Capri Optics 12/1/2016Urban Modern Optical 12/1/2016US 56 Capri Optics 12/1/2016US 74 Capri Optics 12/1/2016US 75 Capri Optics 12/1/2016Visa Modern Optical 12/1/2016Wiggle Modern Optical 12/1/2016
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 4 of 55 Pages
Frame Deletions
Frame Name Manufacturer Date
Baby One 37 Miraflex 9/30/2019Baby One 44 Miraflex 9/30/2019Karen Modern Optical 9/30/2019Nick 50 Miraflex 9/30/2019Nick 53 Miraflex 9/30/2019PT 61 Capri Optics 9/30/2019Yoni Modern Optical 9/30/2019
J5716 (Formerly 1109) Hart Specialties 12/1/20167710 Capri Optics 12/1/20167714 Capri Optics 12/1/20167716 Capri Optics 12/1/20167725 Capri Optics 12/1/20167726 Capri Optics 12/1/20167731 Capri Optics 12/1/2016Adventure Modern Optical 12/1/2016Alma Modern Optical 12/1/2016Banzai Modern Optical 12/1/2016Blanche Kenmark 12/1/2016Capricorn Modern Optical 12/1/2016Chad Zimco Optics 12/1/2016Compliment Modern Optical 12/1/2016Cyclone Modern Optical 12/1/2016Dawn Modern Optical 12/1/2016Dazzle Modern Optical 12/1/2016Doug Kenmark 12/1/2016Dynamite Modern Optical 12/1/2016Erin Modern Optical 12/1/2016F002 Kenmark 12/1/2016Finale Modern Optical 12/1/2016Fraser Capri Optics 12/1/2016G 507 Kenmark 12/1/2016Hide & Seek Modern Optical 12/1/2016Iris Modern Optical 12/1/2016Kensington Capri Optics 12/1/2016
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 5 of 55 Pages
Frame Deletions
Frame Name Manufacturer Date
Kiwi Capri Optics 12/1/2016Lisa Modern Optical 12/1/2016Loner Modern Optical 12/1/2016Matrix Modern Optical 12/1/2016Midnight Modern Optical 12/1/2016Neon Modern Optical 12/1/2016Norma Modern Optical 12/1/2016PT 59 Capri Optics 12/1/2016PT 62 Capri Optics 12/1/2016PT 70 Capri Optics 12/1/2016S-310 Zimco Optics 12/1/2016S-311 Zimco Optics 12/1/2016S-324 Zimco Optics 12/1/2016Shock Modern Optical 12/1/2016Shortstop Modern Optical 12/1/2016Smith Kenmark 12/1/2016Sonia Modern Optical 12/1/2016SP 83 Titmus 12/1/2016Storm Modern Optical 12/1/2016Swift Modern Optical 12/1/2016Todd Modern Optical 12/1/2016U 17 Capri Optics 12/1/2016U 31 Capri Optics 12/1/2016U 33 Capri Optics 12/1/2016U 35 Capri Optics 12/1/2016U 37 Capri Optics 12/1/2016UL 90 Capri Optics 12/1/2016UL 91 Capri Optics 12/1/2016UM 73 Capri Optics 12/1/2016US 55 Capri Optics 12/1/2016US 57 Capri Optics 12/1/2016VS 502 Capri Optics 12/1/2016Wayne Modern Optical 12/1/2016
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 6 of 55 Pages
Infants'/Toddlers' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
Cheerful Modern Optical Metal StandardCutie Modern Optical Metal StandardJunior Modern Optical Metal StandardLollipop - Cable Modern Optical Metal StandardLollipop - Skull Modern Optical Metal StandardMainstreet 415 Hart Specialties Plastic StandardPumpkin - Cable Modern Optical Metal StandardPumpkin - Skull Modern Optical Metal StandardSneakers Modern Optical Plastic StandardWiggle Modern Optical Plastic StandardWindy Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 7 of 55 Pages
Boys' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
7719 Capri Optics Metal StandardAries Modern Optical Metal StandardBrave Modern Optical Plastic StandardCare Modern Optical Plastic StandardCheerful Modern Optical Metal StandardChill Modern Optical Plastic StandardClout Modern Optical Plastic StandardCosmo Modern Optical Plastic StandardCutie Modern Optical Metal StandardEqual Modern Optical Plastic StandardExclusive 157 Continental Optical Metal; Nylon Rimless StandardForbidden Modern Optical Plastic StandardJazz Modern Optical Metal StandardJunior Modern Optical Metal StandardKeith Modern Optical Metal StandardKeynote Modern Optical Metal StandardKody Modern Optical Metal StandardL6003 Lantis Optical Plastic StandardL6005 Lantis Optical Metal StandardL6007 Lantis Optical Metal StandardL6009 Lantis Optical Metal StandardL6010 Lantis Optical Metal StandardL6012 Lantis Optical Metal StandardL7003 Lantis Optical Metal StandardL7004 Lantis Optical Metal StandardL7005 Lantis Optical Metal StandardL8001 Lantis Optical Metal StandardL8002 Lantis Optical Plastic StandardL8003 Lantis Optical Metal StandardL8004 Lantis Optical Metal StandardL8005 Lantis Optical Metal StandardL8006 Lantis Optical Plastic StandardL8007 Lantis Optical Plastic StandardL8008 Lantis Optical Metal Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 8 of 55 Pages
Boys' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
L8009 Lantis Optical Metal StandardL8010 Lantis Optical Metal StandardL8011 Lantis Optical Metal StandardL8012 Lantis Optical Metal StandardL8015 Lantis Optical Plastic StandardL8018 Lantis Optical Plastic StandardL8019 Lantis Optical Plastic StandardL8020 Lantis Optical Plastic StandardL8021 Lantis Optical Metal StandardL8022 Lantis Optical Metal StandardL8023 Lantis Optical Metal StandardL8024 Lantis Optical Metal StandardL8029 Lantis Optical Plastic StandardL8030 Lantis Optical Plastic StandardLaunch Modern Optical Plastic StandardLollipop - Cable Modern Optical Metal StandardLollipop - Skull Modern Optical Metal StandardMainstreet 415 Hart Specialties Plastic StandardNinja Modern Optical Metal StandardParallel Modern Optical Plastic StandardPrecise Modern Optical Plastic StandardPT 67 Capri Optics Metal StandardPT 84 Capri Optics Metal StandardPT 85 Capri Optics Metal StandardPumpkin - Cable Modern Optical Metal StandardPumpkin - Skull Modern Optical Metal StandardSlick Modern Optical Plastic StandardSneakers Modern Optical Plastic StandardTakeoff Modern Optical Plastic StandardTomorrow Modern Optical Plastic StandardU 21 Capri Optics Plastic StandardU 23 Capri Optics Plastic StandardU 39 Capri Optics Plastic StandardUM 70 Capri Optics Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 9 of 55 Pages
Boys' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
Urban Modern Optical Plastic StandardUS 54 Capri Optics Plastic StandardUS 74 Capri Optics Plastic StandardUS 75 Capri Optics Plastic StandardWiggle Modern Optical Plastic StandardWindy Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 10 of 55 Pages
Girls' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
7719 Capri Optics Metal StandardAries Modern Optical Metal StandardBrave Modern Optical Plastic StandardCare Modern Optical Plastic StandardCheerful Modern Optical Metal StandardChill Modern Optical Plastic StandardClout Modern Optical Plastic StandardCosmo Modern Optical Plastic StandardCutie Modern Optical Metal StandardEqual Modern Optical Plastic StandardExclusive 157 Continental Optical Metal; Nylon Rimless StandardForbidden Modern Optical Plastic StandardFregossi 368 Continental Optical Plastic StandardJazz Modern Optical Metal StandardJunior Modern Optical Metal StandardKody Modern Optical Metal StandardL6001 Lantis Optical Plastic StandardL6002 Lantis Optical Plastic StandardL6003 Lantis Optical Plastic StandardL6004 Lantis Optical Plastic StandardL6005 Lantis Optical Metal StandardL6007 Lantis Optical Metal StandardL6009 Lantis Optical Metal StandardL6010 Lantis Optical Metal StandardL6012 Lantis Optical Metal StandardL7003 Lantis Optical Metal StandardL7004 Lantis Optical Metal StandardL7005 Lantis Optical Metal StandardL8001 Lantis Optical Metal StandardL8002 Lantis Optical Plastic StandardL8003 Lantis Optical Metal StandardL8004 Lantis Optical Metal StandardL8005 Lantis Optical Metal StandardL8006 Lantis Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 11 of 55 Pages
Girls' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
L8007 Lantis Optical Plastic StandardL8008 Lantis Optical Metal StandardL8009 Lantis Optical Metal StandardL8010 Lantis Optical Metal StandardL8011 Lantis Optical Metal StandardL8012 Lantis Optical Metal StandardL8013 Lantis Optical Plastic StandardL8014 Lantis Optical Plastic StandardL8015 Lantis Optical Plastic StandardL8017 Lantis Optical Plastic StandardL8021 Lantis Optical Metal StandardL8022 Lantis Optical Metal StandardL8023 Lantis Optical Metal StandardL8024 Lantis Optical Metal StandardL8026 Lantis Optical Plastic StandardL8027 Lantis Optical Plastic StandardL8028 Lantis Optical Plastic StandardL8029 Lantis Optical Plastic StandardL8030 Lantis Optical Plastic StandardLaunch Modern Optical Plastic StandardLollipop - Cable Modern Optical Metal StandardLollipop - Skull Modern Optical Metal StandardLulu Modern Optical Plastic StandardMainstreet 415 Hart Specialties Plastic StandardNinja Modern Optical Metal StandardParallel Modern Optical Plastic StandardPixie Modern Optical Plastic StandardPrecise Modern Optical Plastic StandardPT 67 Capri Optics Metal StandardPT 84 Capri Optics Metal StandardPT 85 Capri Optics Metal StandardPumpkin - Cable Modern Optical Metal StandardPumpkin - Skull Modern Optical Metal StandardSadie Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 12 of 55 Pages
Girls' Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
Slick Modern Optical Plastic StandardSneakers Modern Optical Plastic StandardTakeoff Modern Optical Plastic StandardTomorrow Modern Optical Plastic StandardU 14 Capri Optics Plastic StandardU 21 Capri Optics Plastic StandardU 23 Capri Optics Plastic StandardU 39 Capri Optics Plastic StandardUM 70 Capri Optics Plastic StandardUrban Modern Optical Plastic StandardUS 53 Capri Optics Plastic StandardUS 54 Capri Optics Plastic StandardUS 56 Capri Optics Plastic StandardUS 74 Capri Optics Plastic StandardUS 75 Capri Optics Plastic StandardVisa Modern Optical Plastic StandardWiggle Modern Optical Plastic StandardWindy Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 13 of 55 Pages
Men's Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
7719 Capri Optics Metal StandardAgree Modern Optical Plastic StandardBrave Modern Optical Metal StandardCheerful Modern Optical Metal StandardChill Modern Optical Plastic StandardClout Modern Optical Plastic StandardCosmo Modern Optical Plastic StandardDoug Modern Optical Metal StandardEqual Modern Optical Plastic StandardExclusive 157 Continental Optical Metal; Nylon Rimless StandardJames Modern Optical Metal StandardJazz Modern Optical Metal StandardJunior Modern Optical Metal StandardKeith Modern Optical Metal StandardKody Modern Optical Metal StandardL6003 Lantis Optical Plastic StandardL6007 Lantis Optical Metal StandardL7001 Lantis Optical Metal StandardL7002 Lantis Optical Plastic StandardL7003 Lantis Optical Metal StandardL7004 Lantis Optical Metal StandardL7005 Lantis Optical Metal StandardL7006 Lantis Optical Plastic StandardL7007 Lantis Optical Plastic StandardL7008 Lantis Optical Plastic StandardL7009 Lantis Optical Metal StandardL7010 Lantis Optical Metal StandardL7011 Lantis Optical Metal StandardL7012 Lantis Optical Metal StandardL7015 Lantis Optical Plastic StandardL7016 Lantis Optical Plastic StandardL7017 Lantis Optical Plastic StandardL8021 Lantis Optical Metal StandardLaunch Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 14 of 55 Pages
Men's Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
Lollipop - Cable Modern Optical Metal StandardLollipop - Skull Modern Optical Metal StandardParallel Modern Optical Plastic StandardPrecise Modern Optical Plastic StandardPT 85 Capri Optics Metal StandardPumpkin - Cable Modern Optical Metal StandardPumpkin - Skull Modern Optical Metal StandardSlick Modern Optical Plastic StandardSneakers Modern Optical Plastic StandardTakeoff Modern Optical Plastic StandardTomorrow Modern Optical Plastic StandardU 21 Capri Optics Plastic StandardU 39 Capri Optics Plastic StandardUM 70 Capri Optics Plastic StandardUrban Modern Optical Plastic StandardUS 54 Capri Optics Plastic StandardUS 75 Capri Optics Plastic StandardVisa Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 15 of 55 Pages
Women's Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
7719 Capri Optics Metal StandardAgree Modern Optical Plastic StandardAries Modern Optical Metal StandardBeth Modern Optical Metal StandardBrave Modern Optical Plastic StandardBria Modern Optical Metal StandardCamille Modern Optical Metal StandardCheerful Modern Optical Metal StandardChill Modern Optical Plastic StandardClout Modern Optical Plastic StandardCosmo Modern Optical Plastic StandardEileen Modern Optical Plastic StandardEqual Modern Optical Plastic StandardExclusive 157 Continental Optical Metal; Nylon Rimless StandardForbidden Modern Optical Plastic StandardFregossi 368 Continental Optical Plastic StandardJazz Modern Optical Metal StandardJunior Modern Optical Metal StandardKody Modern Optical Metal StandardL6001 Lantis Optical Plastic StandardL6002 Lantis Optical Plastic StandardL6003 Lantis Optical Plastic StandardL6004 Lantis Optical Plastic StandardL6005 Lantis Optical Metal StandardL6006 Lantis Optical Metal StandardL6007 Lantis Optical Metal StandardL6008 Lantis Optical Plastic StandardL6009 Lantis Optical Metal StandardL6010 Lantis Optical Metal StandardL6011 Lantis Optical Metal StandardL6012 Lantis Optical Metal StandardL6016 Lantis Optical Plastic StandardL6017 Lantis Optical Plastic StandardL6018 Lantis Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 16 of 55 Pages
Women's Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
L7001 Lantis Optical Metal StandardL7002 Lantis Optical Plastic StandardL7003 Lantis Optical Metal StandardL7004 Lantis Optical Metal StandardL7005 Lantis Optical Metal StandardL7012 Lantis Optical Metal StandardL8021 Lantis Optical Metal StandardL8026 Lantis Optical Plastic StandardL8028 Lantis Optical Plastic StandardLaunch Modern Optical Plastic StandardLilac Capri Optics Metal StandardLollipop - Cable Modern Optical Metal StandardLollipop - Skull Modern Optical Metal StandardLulu Modern Optical Plastic StandardParallel Modern Optical Plastic StandardPrecise Modern Optical Plastic StandardPT 61 Capri Optics Metal StandardPT 84 Capri Optics Metal StandardPT 85 Capri Optics Metal StandardPumpkin - Cable Modern Optical Metal StandardPumpkin - Skull Modern Optical Metal StandardSadie Modern Optical Plastic StandardSlick Modern Optical Plastic StandardSneakers Modern Optical Plastic StandardTakeoff Modern Optical Plastic StandardTomorrow Modern Optical Plastic StandardU 14 Capri Optics Plastic StandardU 21 Capri Optics Plastic StandardU 23 Capri Optics Plastic StandardU 39 Capri Optics Plastic StandardUM 70 Capri Optics Plastic StandardUrban Modern Optical Plastic StandardUS 53 Capri Optics Plastic StandardUS 54 Capri Optics Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 17 of 55 Pages
Women's Frame ListAll frames $4.44 unless otherwise noted
Frame Name Manufacturer Material Category
US 56 Capri Optics Plastic StandardUS 74 Capri Optics Plastic StandardUS 75 Capri Optics Plastic StandardVisa Modern Optical Plastic Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 18 of 55 Pages
Children's Deluxe Frame ListAll Deluxe frames $30.00 unless otherwise noted
Frame Name Manufacturer Material Category
Baby Lux Miraflex Flexible Plastic DeluxeBaby Lux 2 Miraflex Flexible Plastic DeluxeBaby One 1 Miraflex Flexible Plastic DeluxeBaby One 2 Miraflex Flexible Plastic DeluxeBaby Plus Miraflex Flexible Plastic DeluxeBaby Plus 2 Miraflex Flexible Plastic DeluxeBaby Zero Miraflex Flexible Plastic DeluxeBaby Zero 2 Miraflex Flexible Plastic DeluxeEva Miraflex Flexible Plastic DeluxeMaxi Baby Miraflex Flexible Plastic DeluxeMaxi Baby 2 Miraflex Flexible Plastic DeluxeMayan 1 Miraflex Flexible Plastic DeluxeMayan 2 Miraflex Flexible Plastic DeluxeMayan 3 Miraflex Flexible Plastic DeluxeMini Baby Miraflex Flexible Plastic DeluxeModel 1 Specs4Us Titanium Flexible Metal Deluxe Model 2 Specs4Us Titanium Flexible Metal Deluxe Model 3 Specs4Us Titanium Flexible Metal Deluxe Model 4 Specs4Us Titanium Flexible Metal Deluxe Model 5 Specs4Us Titanium Flexible Metal Deluxe Model 6 Specs4Us Titanium Flexible Metal Deluxe Model 7 Specs4Us Titanium Flexible Metal Deluxe Model 8 Specs4Us Titanium Flexible Metal Deluxe Model 9 Specs4Us Titanium Flexible Metal Deluxe Model 11 Specs4Us Titanium Flexible Metal Deluxe Model 12 Specs4Us Titanium Flexible Metal Deluxe Model 13 Specs4Us Titanium Flexible Metal Deluxe Model 14 Specs4Us Titanium Flexible Metal Deluxe Model 15 Specs4Us Titanium Flexible Metal Deluxe Model 16 Specs4Us Titanium Flexible Metal DeluxeNew Baby 1 Miraflex Flexible Plastic Deluxe New Baby 2 Miraflex Flexible Plastic DeluxeNew Baby 3 Miraflex Flexible Plastic DeluxeNew Baby 4 Miraflex Flexible Plastic Deluxe
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 19 of 55 Pages
Children's Deluxe Frame ListAll Deluxe frames $30.00 unless otherwise noted
Frame Name Manufacturer Material Category
Nicki 48 Miraflex Flexible Plastic DeluxeNick 50 Miraflex Flexible Plastic DeluxeNick 53 Miraflex Flexible Plastic Deluxe
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 20 of 55 Pages
Adults' Deluxe Frame ListAll Deluxe frames $30.00 unless otherwise noted
Frame Name Manufacturer Material Category
Model 5 Specs4Us Titanium Flexible Metal Deluxe Model 7 Specs4Us Titanium Flexible Metal Deluxe Model 9 Specs4Us Titanium Flexible Metal Deluxe Model 13 Specs4Us Titanium Flexible Metal Deluxe Model 14 Specs4Us Titanium Flexible Metal Deluxe Model 15 Specs4Us Titanium Flexible Metal Deluxe Model 16 Specs4Us Titanium Flexible Metal Deluxe Nick 50 Miraflex Flexible Plastic DeluxeNick 53 Miraflex Flexible Plastic Deluxe
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 21 of 55 Pages
Deluxe Sport Frame ListAll Deluxe frames $30.00 unless otherwise noted
Frame Name Manufacturer Material Category
Half Court Capri Optics Plastic Deluxe (Sport)Jam’n Hilco Plastic Deluxe (Sport)T-Zone Hilco Plastic Deluxe (Sport)
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 22 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
7719 54-19-145 Black56-19-145 Coffee
Capri Optics 60-19-150 Gunmetal
Metal frame with spring hinge, adjustable nose pads.Standard
Agree 52-16-140 Black/SilverBrown/Gold
Modern Optical Burgundy/Silver
Plastic frame with saddle bridge.Standard
Aries 48-20-140 Brown50-20-145 Gold
Modern Optical Gunmetal
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
Beth 50-18-135 Antique Silver52-18-140 Gold
Modern Optical Matte BrownRose
Metal frame with spring hinge, adjustable nose pads.Standard
Brave 50-15-135 Black52-15-140 Blue
Modern Optical Brown
Plastic frame with saddle bridge.Standard
Bria 53-16-135 BrownLilac
Modern Optical Rose
Metal frame with spring hinge, adjustable nose pads.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 23 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Camille 51-19-135 GunmetalLight Brown
Modern Optical Rose
Metal frame with spring hinge, adjustable nose pads.Standard
Care 42-15-125 Black/Crystal44-15-130 Navy/Crystal
Modern Optical 46-15-135 Pink/CrystalPurple/Crystal
Plastic frame with saddle bridge.Standard
Cheerful 40-18-120 Amber42-18-125 Black
Modern Optical 44-18-130 BrownPinkGold
Metal frame with spring hinge, adjustable nose pads.Standard
Chill 51-17-140 Black/BlueBlack/Lime
Modern Optical Black/PinkBlack/Purple
Black/RedBlack/WhiteBlack/Lilac
Black/OrangeBlack/Turquoise
Plastic frame with saddle bridge.Standard
Clout 53-16-145 BlackBrown
Modern Optical Grey
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 24 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Cosmo 48-20-145 Black50-20-150 Brown Fade
Modern Optical 50-22-150 Gray Fade52-22-15052-24-15054-22-15054-24-150
Plastic frame with saddle bridge.Standard
Cutie 32-15-115 Brown35-15-120 Gold
Modern Optical Purple
Metal frame with spring hinge, adjustable nose pads.Standard
Doug 52-20-140 Antique Silver54-20-145 Gold
Modern Optical 56-20-145 Matte Brown
Metal frame with spring hinge, adjustable nose pads.Standard
Eileen 56-17-140 Black/CrystalBrown/Crystal
Modern Optical Burgundy/Pink
Plastic frame with spring hinge, saddle bridge, laser engraved temples, multi-faceted gemstones.Standard
Equal 50-19-140 Black/GreyBlack/Pink
Modern Optical Black/PurpleBlack/Red
Black MattePlastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 25 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Exclusive 157 51-19-140 BrownGunmetal
Continental Optical Matte Black
Metal nylon rimless frame with spring hinge, adjustable nose pads.Standard
Forbidden 48-18-140 BlackTortoise
Modern Optical Wine
Plastic frame with spring hinge, saddle bridge.Standard
Fregossi 368 50-18-135 AquaBlack
Continental Optical Sunset
Plastic frame with spring hinge, saddle bridge.Standard
James 56-17-140 Coffee58-17-145 Gold
Modern Optical 60-17-150 Gunmetal
Metal frame with spring hinge, adjustable nose pads.Standard
Jazz 52-18-140 Black54-18-145 Brown
Modern Optical 56-18-150 Gunmetal58-18-15560-18-155
Metal frame with spring hinge, adjustable nose pads.Standard
Junior 35-18-115 Blue 37-18-120 Demi Amber
Modern Optical 39-18-125 Rose41-18-125
Metal frame with spring hinge, adjustable nose pads.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 26 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Keith 54-16-140 Antique Silver56-16-145 Gold
Modern Optical 58-16-150 Matte Brown
Metal frame with spring hinge, adjustable nose pads.Standard
Keynote 51-17-135 Matte BlackMatte Brown
Modern Optical Matte Plum
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
Kody 52-18-140 Black54-18-145 Brown
Modern Optical Gunmetal
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6001 52-16-130 Black/Crystal54-16-135 Purple/Crystal
Lantis Wine/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L6002 52-14-130 Black/Honey Brown/Crystal
Lantis Dark Plum/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L6003 52-16-130 Black/Crystal54-16-135 Brown/Crystal
Lantis Purple/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 27 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L6004 50-16-138 Black/Magenta52-16-135 Black/Honey
Lantis Wine/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L6005 51-19-130 Shiny Wine Satin Brown
Lantis Shiny Black
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6006 52-18-135 Satin Brown Satin Plum
Lantis Shiny Wine
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6007 53-18-138 Shiny Wine Satin Gold
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6008 51-17-130 Pink/Crystal Brown/Crystal
Lantis Rose/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 28 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L6009 48-18-125 Satin Brown Shiny Wine
Lantis Satin Gold
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6010 49-16-130 Satin Brown Satin Black
Lantis Satin Silver
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6011 50-18-130 Satin Pink Satin Brown
Lantis Satin Plum
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6012 49-18-130 Satin Plum Satin Brown
Lantis Shiny Wine
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L6016 53-17-135 LavenderBlack
Lantis Tortoise
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 29 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L6017 52-16-135 BlackBrown
Lantis Purple
Plastic frame with saddle bridge.Standard
L6018 52-17-145 BurgundyBlack
Lantis Lavender
Plastic frame with saddle bridge.Standard
L7001 54-18-138 Matte Black Satin Brown
Lantis Satin Gold
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7002 53-16-138 Shiny Black55-16-140 Charcoal/Crystal
Lantis Brown/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L7003 52-19-140 Satin Brown Matte Black
Lantis Satin Gunmetal
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 30 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L7004 52-18-135 Satin Gunmetal Satin Brown
Lantis Matte Black
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7005 50-19-135 Satin Gunmetal Satin Gold
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7006 55-17-140 Black/Crystal57-17-145 Brown/Crystal
Lantis Tortoise
Plastic frame with spring hinge, saddle bridge.Standard
L7007 53-15-145 Shiny Black55-17-145 Brown/Crystal
Lantis Tortoise
Plastic frame with spring hinge, saddle bridge.Standard
L7008 53-17-135 Black/Crystal Brown/Crystal
Lantis Tortoise
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 31 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L7009 58-19-150 Satin Brown Dark Gunmetal
Lantis Satin Gold
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7010 54-20-140 Matte Black Satin Gunmetal
Lantis Satin Gold
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7011 54-18-145 Satin Dark Brown Satin Gunmetal
Lantis Matte Black
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7012 51-18-135 Satin Gunmetal Satin Brown
Lantis Matte Black
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L7015 52-18-140 BlackGray
Lantis Navy
"Cold Insert"Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 32 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L7016 55-15-140 GrayBlack
Lantis Tortoise
Plastic frame with saddle bridge.Standard
L7017 52-17-145 GrayMatte Black
Lantis Tortoise
Plastic frame with saddle bridge.Standard
L8001 44-18-125 Satin Brown Satin Gunmetal
Lantis Satin Navy
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8002 46-15-125 Black/Crystal Brown/Crystal
Lantis Purple/Pink Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L8003 48-17-135 Matte Black/Navy Satin Brown/Brown
Lantis Satin Gunmetal/Black
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 33 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L8004 47-17-130 Satin Pink Satin Brown
Lantis Satin Gunmetal
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8005 36-17-140 Satin Light Brown38-17-140
Lantis 40-18-140
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8006 45-15-128 Navy/Crystal Brown/Crystal
Lantis Black/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L8007 47-16-130 Black/Crystal49-16-130 Brown/Crystal
Lantis Red/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L8008 44-19-130 Satin Gunmetal Satin Slate Blue
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 34 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L8009 46-18-130 Satin Light Plum Satin Gunmetal
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8010 45-19-125 Satin Pink Satin Red
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8011 42-18-120 Slate Blue Satin Brown
Lantis Satin Light Plum
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8012 46-18-125 Satin Brown Satin Pink
Lantis Slate Blue
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8013 47-16-130 Brown/Crystal Black/Crystal
Lantis Blue/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 35 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L8014 48-16-130 Black/Magenta50-16-130 Purple/Pink
Lantis Black/Green
Plastic frame with spring hinge, saddle bridge.Standard
L8015 45-17-126 Teal/Crystal Purple/Crystal
Lantis Pink/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
L8016 45-16-127 Black/Green Brown/Crystal
Lantis Red/Crystal
Plastic frame with saddle bridge.Standard
L8017 46-17-130 Purple/Crystal Black
Lantis Magenta/Crystal
Plastic frame with saddle bridge.Standard
L8018 42-16-128 Teal Blue/Crystal45-16-130 Black/Crystal
Lantis Pink/Crystal
Plastic frame with saddle bridge.Standard
L8019 45-13-128 Purple/Crystal Navy/Crystal
Lantis Brown/Crystal
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 36 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L8020 46-16-135 Black48-14-128 Brown/Crystal
Lantis Navy Crystal
Plastic frame with saddle bridge.Standard
L8021 50-17-130 Satin Gunmetal Matte Black
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8022 47-15-130 Satin Navy Satin Gunmetal
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8023 48-16-135 Satin Magenta Satin Purple
Lantis Satin Brown
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
L8024 48-16-130 Satin Black/Purple Satin Brown
Lantis Satin Plum
Metal frame with spring hinge, adjustable nose pads, plastic temples.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 37 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
L8026 48-15-130 BlackNavy
Lantis Tortoise
Plastic frame with saddle bridge.Standard
L8027 46-15-130 RoseBlack
Lantis Red
Plastic frame with saddle bridge.Standard
L8028 48-17-130 RedBlack
Lantis Teal
Plastic frame with saddle bridge.Standard
L8029 46-17-130 BlackNavy
Lantis Tortoise
Plastic frame with saddle bridge.Standard
L8030 44-16-125 NavyBlack
Lantis Tortoise
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 38 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Launch 51-18-140 Matte Black/GreyMatte Black/Red
Modern Optical Matte Black/White
Plastic frame with saddle bridge.Standard
Lilac 49-18-130 Coffee51-18-135 Demi Amber
Capri Optics Gold/Silver
Metal frame with spring hinge, adjustable nose pads.Standard
Lollipop Cable 39-20-130 Amber
41-20-135 BrownModern Optical 43-20-140 Rose
Metal frame with spring hinge, adjustable nose pads, cable temples.Standard
Lollipop Skull 39-20-120 Amber
41-20-125 BrownModern Optical 43-20-125 Rose
Metal frame with spring hinge, adjustable nose pads.Standard
Lulu 50-16-135 Black/RoseBlack/Violet
Modern Optical Brown
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 39 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Mainstreet 415 33-20-115 Blue36-20-120 Brown
Hart Specialties 39-20-125 Pink
Plastic frame with spring hinge, saddle bridge, cable temples.Standard
Ninja 44-18-130 Matte Black46-18-135 Matte Blue
Modern Optical Matte BrownMatte Burgundy
VioletMetal frame with spring hinge, adjustable nose pads.Standard
Parallel 53-20-145 Blue FadeBurgundy Fade
Modern Optical Grey Fade
Plastic frame with saddle bridge.Standard
Pixie 48-16-130 Black/CrystalBrown/Crystal
Modern Optical Plum/Crystal
Plastic frame with spring hinge, saddle bridge, laser engraved-heart design, multi-faceted gemstone.Standard
Precise 51-18-140 Black/CrystalGrey
Modern Optical Red
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 40 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
PT 67 44-16-125 BurgundyCoffee
Capri Optics Denim
Metal frame with spring hinge, adjustable nose pads.Standard
PT 84 42-17-125 Black45-17-130 Brown
Capri Optics 48-19-135 Blue
Metal frame with spring hinge, adjustable nose pads.Standard
PT 85 54-18-145 Black56-18-150 Gunmetal
Capri Optics Brown
Metal frame with spring hinge, adjustable nose pads.Standard
PumpkinCable 40-16-130 Black
42-16-135 BlueModern Optical Brown
Goldtone
Metal frame with spring hinge, adjustable nose pads, cable temples.Standard
PumpkinSkull 40-16-120 Black
42-16-125 BlueModern Optical Brown
Goldtone
Metal frame with spring hinge, adjustable nose pads.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 41 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Sadie 49-18-135 BlackBrown
Modern Optical Burgundy
Plastic frame with spring hinge, saddle bridge, laser engraved floral design, multi-faceted gemstones.Standard
Slick 49-17-135 Black51-17-140 Tortoise
Modern Optical 54-17-145 White57-17-150 Red60-17-150 Crystal
Plastic frame with spring hinge, saddle bridge.Standard
Sneakers 42-18-125 Blonde45-18-130 Brown/Blue
Modern Optical 47-18-135 Wine/Grey
Plastic frame with saddle bridge.Standard
Takeoff 47-17-135 Black/Blue49-17-140 Black/Grey
Modern Optical Black/Hot Pink
Plastic frame with saddle bridge.Standard
Tomorrow 51-17-135 Black53-17-140 Brown
Modern Optical 55-17-145 Grey
Plastic frame with spring hinge, saddle bridge.Standard
U 14 48-18-140 Black AmberBrown
Capri Optics Grey Marble
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 42 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
U 21 50-18-145 BlackBrown
Capri Optics Brown Blue
Plastic frame with saddle bridge.Standard
U 23 48-20-140 Black CrystalBrown
Capri Optics Grey Marble
Plastic frame with saddle bridge.Standard
U 39 51-17-140 BlackBrown
Capri Optics Grey
Plastic frame with saddle bridge.Standard
UM 70 52-22-140 Black54-22-145 Brown
Capri Optics Grey
Plastic frame with saddle bridge.Standard
Urban 51-17-140 BlackCrystal
Modern Optical Navy-TortoiseTortoise
Plastic frame with saddle bridge.Standard
US 53 51-19-140 Black CrystalBrown Crystal
Capri Optics Wine
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 43 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
US 54 56-17-140 BrownBlack
Capri Optics Wine
Plastic frame with saddle bridge.Standard
US 56 51-18-135 BrownGrey
Capri Optics Tortoise
Plastic frame with saddle bridge.Standard
US 74 51-17-135 Black53-17-140 Brown
Capri Optics PurpleWine
Plastic frame with spring hinge, saddle bridge.Standard
US 75 51-17-140 Black54-17-145 Grey
Capri Optics Tortoise
Plastic frame with spring hinge, saddle bridge.Standard
Visa 54-17-140 Black/CrystalBrown/Crystal
Modern Optical Navy/Crystal
Plastic frame with spring hinge, saddle bridge.Standard
Wiggle 40-16-120 Black42-16-125 Brown
Modern Optical 44-16-130 Purple
Plastic frame with spring hinge, saddle bridge.Standard
X10A0H
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 44 of 55 Pages
Standard Frames
Frame Name Manufacturer Size Picture and Description Color
Windy 41-17-120 Black/Crystal43-17-125 Brown/Crystal
Modern Optical Violet/Crystal
Plastic frame with saddle bridge.Standard
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 45 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Baby Lux 38-17 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Baby Lux 2 40-18 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Baby One 37-14 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Baby One 2 44-16 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 46 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Baby Plus 39-14 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Baby Plus 2 42-14 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Baby Zero 31-15 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Baby Zero 2 34-15 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 47 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Eva 42-16 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Maxi Baby 38-12 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Maxi Baby 2 40-15 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Mayan 1
Miraflex
39-14
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Multiple Colors(See Last Page)
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 48 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Mayan 2
Miraflex
42-15
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Multiple Colors(See Last Page)
Mayan 3
Miraflex
47-17
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Multiple Colors(See Last Page)
Mini Baby 34-15 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Model 1 35-16-105 Brown38-16-110 Pink
Specs4Us 40-16-110 Navy43-18-120 Violet
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Model 2 40-16-110 Pink43-16-120 Violet
Specs4Us 46-18-125 Wine
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 49 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Model 3 38-16-110 Eye Sizes 38, 40,43, 4640-16-110 Blue Demi
Specs4Us 43-18-120 Green Light46-18-125 Violet
Eye Sizes 43 and 46Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.
Blue Light
Deluxe-Durable
Model 4 41-16-115 Green Dark43-16-120 Gunmetal Light
Specs4Us 46-18-125 Pink Pink Demi
NavyMemory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Model 5 48-18-125 Black Demi51-18-125 Brown/Silver Matte
Specs4Us Green DarkGunmetal Light
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Model 6 33-15-110 Eye Size 3335-16-105 Brown
Specs4Us 38-16-110 Pink41-16-11543-18-120 Eye Sizes 35, 38, 41, 43
Blue DemiGunmetal Light
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.
BrownPink
Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 50 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Model 7 42-16-120 Brown45-16-120 Navy
Specs4Us 48-20-125 RedViolet Dark
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Model 8 43-16-120 Brown46-18-125 Brown/Silver Matte
Specs4Us Gold DemiNavy
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Model 9 35-16-105 Eye Sizes 35, 38, 40, 43
38-16-110 Green DarkSpecs4Us 40-16-110 Gunmetal Dark
43-16-120 Pink Demi
46-18-125 Wine48-18-125
Eye Sizes 38, 43Navy
Eye Sizes 46, 48
AquaMemory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.
Pink AntiqueBlue
Brown/Silver MatteDeluxe-Durable
Model 11 38-17-105 Eye Sizes 38, 40, 4340-17-120 Blue Bright
Specs4Us 43-17-120 BrownBlack ShinyWine Matte
Eye Size 43
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.
Dark Violet
Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 51 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Model 12 46-18-120 Gunmetal Dark Matte48-18-125 Matte Brown
Specs4Us Wine MatteDark Violet
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.
Deluxe-Durable
Model 13 43-20-120 Brown 46-20-125 Green Dark Matte
Specs4Us 48-22-130 Wine Matte51-22-130 Black
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Model 14 43-18-120 Eye Sizes 43, 46, 4846-20-125 Navy
Specs4Us 48-20-130 VioletBrown & Silver
Eye Sizes 43, 46Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.
Light Green
Deluxe-Durable
Model 15 46-20-125 Eye Sizes 46, 48, 5448-20-130 Brown/Lt. Orange
Specs4Us 54-22-135 Navy/Lt. BlueBlack/Lt. Gray
Eye Sizes 46, 48Red/Pink Matte
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 52 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Model 16
Specs4Us
43-17-12046-20-12551-20-130
Memory flexible metal, titanium, 180˚ spring hinges, hypoallergenic, soft plastic nose pads, memory flex bridges, wider end pieces for proper fit.Deluxe-Durable
Matte BlackMatte Brown
Turquiose
New Baby 1 39-17 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
New Baby 2 42-16 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
New Baby 3 45-17 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 53 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
New Baby 4 47-17 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Nicki 48 48-16 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Nicki 50 50-19 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Nicki 53 53-19 Multiple Colors(See Last Page)
Miraflex
Flexible Plastic - Soft frames made of flexible material with no metal components or hinges, saddle bridge, includes headband, hypoallergenic.Deluxe-Durable
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 54 of 55 Pages
Deluxe-Durable Frames
Frame Name Manufacturer Size Picture and Description Color
Half Court 45-18-120 Clear
Capri Optics
Plastic, Rx Capable.Deluxe-Sport
Jam'n 52-15-STD Black54-15-STD Navy
Hilco RedSilver
Plastic, Rx Capable.Deluxe-Sport
T-Zone 55-17-120 Black59-17-120 Navy
Hilco 62-20-125 Red SilverClear
Plastic, Rx Capable.Deluxe-Sport
Effective December 1, 2016Revised September 30, 2019
Classic Optical Wisconsin Medicaid Frame Brochure Page 55 of 55 Pages
MIRAFLEX
Flexible & Safe Color
Baby Zero
31/15
Mini Baby 34/15
Baby Zero2 34/15
BabyOne 37/14
Baby Lux 38/17
Maxi Baby 38/12
Baby Plus
39/14
Mayan1 39
39/14
New Baby1 39/17
Baby Lux2 40/18
Maxi Baby2 40/15
Baby Plus 2 42/14
Mayan2 42
42/15New Baby2
42/16Eva
42/16
Baby One 2 44/16
New Baby3 45/17
Mayan 347/17
New Baby 4 47/17
Nicki 48/16
Nicki 50 50/19
Nicki 53 53/19
Reference BZ.31 M1.34 BZ2.34 B1.37 MBL.38 MB.38 BP.39 √ NB1.39 MBL2.40 MB2.40 BP2.42 √ NB2.42 EVA.42 B1.44 NB3.45 √ NB4.47 Ni.48 N.50 N.53
B - Pink B B B 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
BCP - Clear Pink Pearl BCP BCP BCP BCP BCP BCP BCP BCP BCP BCP BCP
BP - Blush Pink BP BP BP BP BP BP
BS - Magenta BS BS BS BS BS BS BS BS BS BS BS
CP -Royal Blue CP CP 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 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 DS
DV - Teal DV DV DV DV DV DV
E - Light Blue E E E E E E
EC - Clear Blue EC EC EC EC EC EC EC EC EC EC EC EC EC EC EC
ECP - Clear Blue Pearl ECP ECP ECP ECP
EP - Light Blue Pearl EP EP EP EP EP EP EP EP EP EP
FC - Clear Beige FC FC FC FC FC FC FC
HP - Yellow Pearl HP HP HP HP HP HP HP HP HP
HSP - Mustard HSP HSP HSP
I - Red I I I I I I I I I I I I I I
IN - Bright Orange IN IN IN
IP - Red Pearl 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 J J J
JC - Clear Gray 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 JS
K - Burgundy K K K
KM - BurgundyMetallic 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 L L L
M - Milk Chocolate M M M M M M M M M M M M M
MM - Dark Brown MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM
N - Fr ost White N N N N N N N N N N N N N N N
NC - White Glitter NC NC NC NC
OM - Indigo 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
S - Lilac S S S S S
V - Green V
VC - Clear Green VC VC VC VC VC
VCP - Clear Green Pearl VCP VCP
VM - Dark Turquoise VM 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
VS - Hunter Green VS VS VS VS VS
Available Frame Color Revised 190703
Unavailable Frame Color
Color Available While Inventory Lasts
