Free Eyeglasses for Retirees

How To Order Retiree

** Do not send a copy of your military ID card or put your full SSN on any of the forms as it is a HIPAA violation and could put you at risk for identity theft **
If you are retired military and are eligible for other medical services, you are authorized to receive the following quantities of standard issue spectacles per year (5A, 5AM or half eye frame):
  • 1 clear pair of Bifocals/Trifocals (Multi-focals)-or-
  • 1 tinted pair of Bifocals/Trifocals if prescribed by your Optometrist/Ophthalmologist
If you choose not to request Bifocals/Trifocals, you can receive:
  • 1 pair of Distance Vision or 1 pair of Near Vision spectacles -or-
  • 1 pair of Distance Vision tinted spectacles if prescribed by your Optometrist/Ophthalmologist

Retired military personnel, regardless of rank, who require vision correction, are authorized one pair of standard issue spectacles or one pair of half-eye spectacles. Two pairs of spectacles may be issued when professionally determined to be essential by the examining provider.
If you are less than 50 miles from a military medical clinic with optometry services, you should take your prescription for spectacles to them so that they may measure you for proper fit. They will order your spectacles from the appropriate military ophthalmic laboratory.
If you are more than 50 miles from a military medical clinic with optometry services, you should follow these instructions to order your glasses:
·Open the DD-771 form found on the standard issue frame ordering section of our web site (this form is created so you can save the information that you type into it).
· Fill out the top section with your “name, “retiree”, and “last 4 of your SSN” along with your shipping and contact information. Fill out all sections highlighted in yellow and make sure to save the form with the information you added.
· Print the partially completed form, and take this with you to your eye exam.
· Ensure that the examining facility writes your prescription on the form and includes your pupillary distance (PD).
·If your examining facility needs eyesize, bridge or temple information, they may find this information on our web site.
·If you currently have standard issue frames please provide the frame size and temple length. (found inside the frame)
·There must be a DD-771 form for each request for eyewear.
·Send the following information to NOSTRA:
· One copy of the completed DD771 form (orders are subject to a DEERS eligibility check)
·Your mailing address, daytime phone number and email address if available
·You may submit your order for eyewear by email, fax or standard mail.
·Email your order to:
·Fax your order to: 757-887-4647.
Make sure you write: “Retiree Order” on the fax.
Please call NOSTRA Customer Service at (757) 887-7600 option 1 if you have any additional questions.
·Standard Mail to:
160 Main Road
Yorktown, VA 23691-9984
You may also call NOSTRA Customer Service Department if you have any problems or questions or you can email us at:
Our Customer Service hours are Monday through Friday from 0630 to 1530, eastern time.
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Here is another unsecured clickable / downloadable online form:

Type in applicable information such as your name, address etc., and write in your social security number once you print the form
so that it is not recorded online from this or any hosting website.

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