Daniel E. Bluthardt, Director Division of Professional Regulation  
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Pat Quinn, Governor

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Mailing Address
Springfield Office:
320 West Washington St
Springfield, IL 62786   

Chicago Office:
James R. Thompson Ctr
100 W. Randolph St
Suite 9-300
Chicago, IL 60601   

Telephone
Springfield Office:

(217)785-0800
(217)782-3414 For Real Estate Calls
(217)524-6735 TDD
(217)782-7645 FAX
Chicago:
(312)814-4500

Optometry Applications



NOTE: PRINT USING BLACK INK ON WHITE PAPER.
COMPLETE THE APPLICATION AND MAIL ALL PAGES
PARTIAL APPLICATIONS WILL NOT BE PROCESSED

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Optometry - Acceptance of Examination  
    THIS PACKET INCLUDES:
    .   Instruction Sheet
    .   Licensure Methods and Definitions
    .   Important Notice-Elder & Child Abuse Reporting
    .   Reference Sheet
    .   Application Jacket
    .   CT Certification by Licensing Agency/Board
    .   ED Certification of Education
    .   VE Verification of Employment Experience
    .   TN-D-OPT HOURS Verification of Diagnostic Training
    .   TN-T-OPT 30 HOURS Verification of 30 Hours of Therapeutic Training
    .   TN-T-OPT 120 HOURS Verification of 120 Hours of Therapeutic Training
    .   Instructions & Application for Illinois Optometric Controlled Substance Registration
Optometry - Endorsement

THIS PACKET INCLUDES:
    .   Instruction Sheet
    .   Licensure Methods and Definitions
    .   Important Notice-Elder & Child Abuse Reporting
    .   Reference Sheet
    .   Application Jacket
    .   CT Certification by Licensing Agency/Board
    .   ED Certification of Education
    .   VE Verification of Employment Experience
    .   TN-D-OPT HOURS Verification of Diagnostic Training
    .   TN-T-OPT 30 HOURS Verification of 30 Hours of Therapeutic Training
    .   TN-T-OPT 120 HOURS Verification of 120 Hours of Therapeutic Training
    .   Instructions & Application for Illinois Optometric Controlled Substance Registration 
                        
Optometry Ancillary Office Application

THIS PACKET INCLUDES: . Optometry Ancillary Office Application
Optometry Controlled Substance Application

    THIS PACKET INCLUDES:
    .   Optometrists Instruction Sheet
    .   Application for State Controlled Substances Registration

Optometry Residence

    THIS PACKET INCLUDES:
    .   Instruction Sheet
    .   Important Notice-Elder & Child Abuse Reporting
    .   Application Jacket
    .   CT Certification by Licensing Agency/Board
    .   TN-R-OP Certification of Acceptance for Optometric Residency
    .   TN-D-OPT HOURS Verification of Diagnostic Training
    .   TN-T-OPT 30 HOURS Verification of 30 Hours of Therapeutic Training
    .   TN-T-OPT 120 HOURS Verification of 120 Hours of Therapeutic Training
    .   Instructions & Application for Illinois Optometric Controlled Substance Registration
Restoration 
Forms must be obtained from the Department of Professional Regulation.
 

 

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