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Application & Instructions for Optometry Licensure

Your will need to download and print the following documents:

To view a PDF file you will need the free Adobe Acrobat Reader

If you do not have adobe acrobat, or if you would prefer to receive an application packet by mail, you may obtain one by contacting the Optometry Board at (317) 234-2054 or email us at pla8@pla.IN.gov or FAX us at (317) 233-4236. Please specify that you are requesting an Optometry application with your name and full mailing address. You may also request an application by writing to:

Indiana Professional Licensing Agency
ATTN: Indiana Optometry Board
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

Statutes and Administrative Rules which pertain to the practice of optometry are available to download as stated above. If you would prefer to have a copy sent to you, please submit your request in writing with a fee of $3.00 to the address listed below.

Please specify that you are requesting a Optometry application for licensure and your name and full mailing address.

APPLICANT INFORMATION

JURISPRUDENCE EXAMINATION
All applicants for licensure as an optometrist, by examination or by endorsement, must pass a written jurisprudence examination. Applicants will be notified and sent a schedule of dates in which to take the jurisprudence examination after approval by the Board. The jurisprudence examination will cover the optometry statute and rules, optometric legend drug statute and rules, the Health Professions Standards of Practice, and the access to Health Records. A score of 75 or above on the examination is passing.

TREATMENT AND MANAGEMENT OF OCULAR DISEASE EXAMINATION (TMOD) IS A REQUIREMENT FOR LICENSURE
According to 851 IAC 1-1.1-4, all applicants by examination or endorsement who apply for licensure in the state of Indiana must have a passing score in all parts of the National Board Examiners in Optometry examination including the treatment and management of ocular disease examination (TMOD). The TMOD examination, which is administered by the National Board of Examiners in Optometry, is required by all applicants.

IF AN APPLICANT HAS NOT TAKEN AND PASSED PART III OF THE NATIONAL BOARD OF EXAMINERS IN OPTOMETRY (NBEO) EXAMINATION
Prior to 1994, if an applicant did not take and pass Part III of the National Board of Examiners in Optometry examination, the applicant is required to provide a statement from the appropriate agency in each state where the applicant has been licensed by examination, holds an active license, and from which the applicant is endorsing, certifying the areas of the examination, type of examination, pass-fail criteria, and the applicant's score in each area of the examination.

In order to qualify for an Indiana license, the applicant must have attained an average score of 75, with no score below 65, on a hands-on clinical test in the areas indicated on the "Verification of Optometrist State Licensure" form.

The applicant who applies for licensure under this section bears the burden of proving the requirements of the state in which the applicant is currently licensed are equivalent to those requirements of the Board. The applicant shall submit the above documentation, as well as any other documentation, required by the Board, to determine whether the requirements of the other state are equivalent to the Board's.

TESTING ACCOMMODATION REQUEST
If you have a disability, which may require a special accommodation in taking the law examination, please request a TESTING ACCOMMODATION REQUEST FORM from this office by calling (317) 234-2054. If an accommodation is not requested prior to the examination, we cannot guarantee the availability of the accommodation on-site.

ABANDONED APPLICATIONS

An application shall be considered abandoned if the applicant does not complete the requirements for licensure within one (1) year from the date on which the application was filed. An application submitted subsequent to an abandoned application shall be treated as a new application.

EXPIRATION DATE OF OPTOMETRY LICENSE AND OPTOMETRIC LEGEND DRUG CERTIFICATE

OPTOMETRY LICENSE

All optometry licenses expire on April 1, 2008. Optometrists are required to have completed twenty (20) hours of optometry continuing education to renew their optometry license acquired after April 1, 2006. Continuing education is not required for the year in which the initial license was issued.

If a new license was issued between April 1, 2006 and April 1, 2007 then you are required to complete ten (10) hours of continuing education.

If a new license was issued after April 1, 2007 then you are not required to complete continuing education for this renewal period.

OPTOMETRIC LEGEND DRUG CERTIFICATE

All optometric legend drug certificates expire on April 1, 2008. Optometrists are required to have completed twenty (20) hours of optometric legend drug continuing education to renew their optometric legend drug certificate acquired after April 1, 2006.

If a new Optometric Legend Drug certificate was issued between April 1, 2006 and April 1, 2007 then you are required to complete ten (10) hours of continuing education.

If a new Optometric Legend Drug certificate was issued after April 1, 2007 then you are not required to complete continuing education for this renewal period.

APPLICATION INSTRUCTIONS AND DOCUMENTATION REQUIRED

APPLICATION
Mail completed application along with all required documentation listed to the Indiana Professional Licensing Agency at the following address:

Indiana Professional Licensing Agency
ATTN: Indiana Optometry Board
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

AFFIDAVIT
If you answer "yes" to any of the six (6) questions on the application, the applicant must explain fully in a signed and notarized affidavit, meaning an explanation or statement of facts and or events, including all related details. Describe the event including location, date and disposition. If you have a malpractice, provide name(s) of plaintiff(s). Letter from attorneys or insurance companies are not accepted in lieu of your statement, however they may accompany your affidavit.

APPLICATION FEE
Applicants must submit a two hundred dollar ($200.00) application fee, made payable to the Indiana Professional Licensing Agency. This fee may be submitted by cash, check or money order. We cannot accept payment by credit card. ALL FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE.

PHOTOGRAPH
Applicants must submit one (1) acceptable photograph, taken not earlier than one (1) year prior to the date of application dated and signed on the back in the applicant's handwriting, "I certify that this is a true photograph of me". The photograph should be approximately 2 x 3 inches, head and shoulders view of the applicant only, black and white or color, of professional quality. No Polaroid" type photographs, laminated photographs, laminated identification cards or group photographs will be accepted.

OFFICIAL OPTOMETRY TRANSCRIPTS
Applicants must submit an official transcript, certified by the school, recording course grades, certificates and degrees earned in an accredited optometry school. Transcripts, which do not state that you have graduated or completed your optometry degree, are not acceptable for licensure.

NATIONAL BOARD OF EXAMINERS IN OPTOMETRY SCORE REPORT
Applicants must submit an official score report sent directly from the National Board of Examiners in Optometry (NBEO) showing completion of Parts I, II, III and the treatment and management of ocular disease (TMOD) with passing scores in all subjects. You may wish to contact the NBEO office prior to your request to verify the fee and procedures for an official score report at:

National Board of Examiners in Optometry
200 S. College Street #1920
Charlotte, North Carolina 28202
Telephone: (704) 332-9565
Toll Free: (800) 969-3926
FAX: (704) 332-9568
Email: nbeo@optometry.org
Web Page: http://www.optometry.org/

IF AN APPLICANT HAS NOT TAKEN AND PASSED PART III OF THE NATIONAL BOARD OF EXAMINERS IN OPTOMETRY (NBEO) EXAMINATION
Prior to 1994, if an applicant did not take and pass Part III of the National Board of Examiners in Optometry examination, the applicant is required to provide a statement from the appropriate agency in each state where the applicant has been licensed by examination, holds an active license, and from which the applicant is endorsing, certifying the areas of the examination, type of examination, pass-fail criteria, and the applicant's score in each area of the examination.

In order to qualify for an Indiana license, the applicant must have attained an average score of 75, with no score below 65, on a hands-on clinical test in the areas indicated on the verification form. The "Verification of Optometrist State Licensure" form is attached to your application.

The applicant who applies for licensure under this section bears the burden of proving the requirements of the state in which the applicant is currently licensed are equivalent to those requirements of the Board. The applicant shall submit the above documentation, as well as any other documentation, required by the Board, to determine whether the requirements of the other state are equivalent to the Board's.

VERIFICATION OF STATE LICENSURE
Applicants must provide a "Verification of Optometrist State Licensure" form which is included with your application for licensure, from each state in which they are currently, or have ever been, licensed, certified or registered in any regulated health profession or occupation. The top portion of this form should be completed by the applicant and sent to the appropriate state licensing board for their submission to the Indiana Optometry Board. The form may be duplicated if necessary.

NAME CHANGE
An official affidavit indicating any legal name change, a notarized copy of a marriage certificate or divorce decree is acceptable if your name differs from that on any of your documents.