Home / Eye Doctors / Register Register to Become a Participating Eye Doctor Fields marked with an asterisk (*) are required. First and Last Name * Email (Private) * Example: username@domain.com Your email address will not be published to the site. Doctor Type * Doctor of Osteopathic Medicine (D.O.) Ophthalmologist (M.D.) Optometrist (O.D.) Description Practice Name Street Address 1 Street Address 2 City County Adams Allen Ashland Ashtabulaa Athens Auglaize Belmont Brown Butler Carroll Champaign Clark Clermont Clinton Columbiana Coshocton Crawford Cuyahoga Darke Defiance Delaware Erie Fairfield Fayette Franklin Fulton Gallia Geauga Greene Guernsey Hamilton Hancock Hardin Harrison Henry Highland Hocking Holmes Huron Jackson Jefferson Knox Lake Lawrence Licking Logan Lorain Lucas Madison Mahoning Marion Medina Meigs Mercer Miami Monroe Montgomery Morgan Morrow Muskingum Noble Ottawa Paulding Perry Pickaway Pike Portage Preble Putnam Richland Ross Sandusky Scioto Seneca Shelby Stark Summit Trumbull Tuscarawas Union Van Wert Warren Washington Wayne Williams Wood Wyandot Unknown County State Ohio Zip Phone Example: 614-555-5555 — don’t forget the area code Toll Free Phone Website Example: http://domain.com/ — don’t forget the http://