Biennial License Renewal 2026-2028 - Nevada State Board of Optometry

NEVADA STATE BOARD OF OPTOMETRY

Do not use this renewal application to change/add a practice location FOR ANY REASON.
To change/add a location, submit the appropriate form under the For Optometrists tab on
the website first, then complete the renewal application.

OPTOMETRY LICENSE RENEWAL APPLICATION

To submit this application by mail, Click here to download and print this form

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Since your prior license application and/or license renewal application, have you legally changed your name?

Yes (If yes, email admin@nvoptometry.org a copy of your legal name change document, court order granting petition for name change, or marriage license).
No

My full name at the time of my prior license application and/or license renewal application was*

I wish to change my name to, and to display on my optometry license certificate as*

Where would you like your new certificates mailed to:*

By my signature at the conclusion of this application to renew my license to practice optometry in the State of Nevada, I,*

License Number*

1. Are you currently obligated by Court Order for the payment of child support?*

Yes
No

2. Are you currently in your obligations under any Court ordered child support?

Yes
No

3. During the current licensing period, has the DEA or the federal government disciplined you, taken any action on your prescribing privileges, or have you voluntarily surrendered your DEA number, allowed it to lapse, or had a limited certificate issued?

Yes
No
N/A

4. Has any licensing jurisdiction, DEA or a state drug enforcement authority ever imposed discipline on you or limited your ability to prescribe?*

Yes
No
N/A

5. If you answered Yes to Question #4, when and where?*

6. Do you hold a Nevada OPAC (Optometric Pharmaceutical Agents Certificate) formerly known as TPA (Therapeutic Pharmaceutical Agents)?*

Yes (50 CE credit hours are required to renew your license)
No (40 CE credit hours are required to renew your license)

See Board Policy no. 5 for CE details https://nvoptometry.org/board/policies/

7. Have you registered for a PMP (Prescription Monitoring Program) Account with the Nevada State Board of Pharmacy?*

Yes (If yes proceed to Question #8)
No (If no proceed to Question #9)

8. Pursuant to NRS 453.164(7), at least once each six months do you confirm all PMP entries attributed to your name/license are correct and non-fraudulent?

Yes
No

9. My DEA (Drug Enforcement Administration) number is: (If you do not have a DEA#, type “N/A)*

10. My CS (Controlled Substance) number with the Nevada State Board of Pharmacy is: (If you do not have a CS#, type “N/A”)*

Note: If you have a CS#, 2 of your 50 CE hours are required to be related to prescribing opioids, addiction, substance abuse, and/or pain management.

11. Have you been convicted of any drug or alcohol related offense within the current licensing period?*

Yes
No

12. If you answered Yes to Question #11, when, where and case number.*

13. Has the State of Nevada or any jurisdiction issued you a business license to offer optometric services?*

Yes
No

14. If I answered Yes to Question #13, my business license number is:*

My business license is held under the following registered legal name*

15. The assumed or fictitious name of this business is

My percentage of ownership in this business is

If the above listed ownership percentage is anything less than 100%, the following is a list of the name and address of each person holding any ownership interest, and percentage of the optometry practice that he or she owns regardless of size, in the business operating under the assumed or fictitious name at this location. If any owners of the business at this location are entities (such as corporations, companies, partnerships or trusts), I have provided a list of each of those entities’ owners in the ”Comments” section of this application.

Additional owner(s): If this business operating under the assumed or fictitious name at this location has additional owners, add each of them below by clicking the

Additional owner(s): If this business operating under the assumed or fictitious name at this location has additional owners, add each of them below by clicking the

Add Other Owner

Name	Address	City	State	ZIP Code	The listed person/entity’s percentage of ownership is

16. Have you ever served in the Military?*

Yes
No

18. Branches of Service (Check all that apply)

Army/Army Reserve
Marine Corps/Marine Corps Reserve
Navy/Navy Reserve
Air Force/Air Force Reserve
Coast Guard/Coast Guard Reserve
National Guard
Other

Other*

19. Has your spouse ever served in the Military?*

Yes
No

21. Have you ever served on active duty in the Armed Forces of the United States and separated from such service under conditions other than dishonorable?*

21. Have you ever served on active duty in the Armed Forces of the United States and separated from such service under conditions other than dishonorable?

Yes (If you were honorably discharged answer Yes)
No

22. Have you ever been assigned to duty for a minimum of 6 continuous years in the National Guard or a reserve component of the Armed Forces of the United States and separated from such service under conditions other than dishonorable?*

22. Have you ever been assigned to duty for a minimum of 6 continuous years in the National Guard or a reserve component of the Armed Forces of the United States and separated from such service under conditions other than dishonorable?

Yes (If you were honorably discharged answer Yes)
No

23. Have you ever served the Commissioned Corps of the United States Public Health Service or the Commissioned Corps of the National Oceanic and Atmospheric Administration of the United States in the capacity of a commissioned officer while on active duty in defense of the United States and separated from such service under conditions other than dishonorable?*

23. Have you ever served the Commissioned Corps of the United States Public Health Service or the Commissioned Corps of the National Oceanic and Atmospheric Administration of the United States in the capacity of a commissioned officer while on active duty in defense of the United States and separated from such service under conditions other than dishonorable?

Yes (If you were honorably discharged answer Yes)
No

The Board is required to ask Questions #24-27 pursuant to newly codified law in May 2024.

24. Pursuant to NRS 232.0081(1), do you consider yourself a person of “limited English proficiency”? (NRS 232.0081(5)(e) defines “limited English proficiency” as “a person who reads, writes or speaks a language other than English and who cannot readily understand or communicate in the English language in written or spoken form, as applicable, based on the manner in which information is being communicated.”)*

Yes
No

25. Pursuant to NRS 232.0081(1)(b)(2), what is your preferred language?*

26. Pursuant to NRS 232.0081(1)(b)(4), do you consider yourself an indigenous person?*

Yes
No

27. Pursuant to NRS 232.0081(1)(b)(5), do you consider yourself a refugee?*

Yes
No

Preferred Board Communication Mailing Address*

Street Address City State ZIP Code

Preferred Board Communications Email address**

Preferred Board Communications Phone number**

Public Mailing Address*

Street Address City State ZIP Code

Choose From Below Options*

I wish to RENEW AN INACTIVE LICENSE ($550.00 for 2-year license)
I wish to RENEW AN ACTIVE LICENSE ($900.00 for 2-year license and one practice location)

RENEW AN ACTIVE LICENSE

Choose One:

Primary Practice location address. (In the event you do not practice in Nevada but wish to have an active license, use your home address as your primary location)
Substitute optometry certificate. (This option is for “fill-in” or “floating” optometrists and requires that you submit a quarterly log of your substitute optometrist locations to admin@nvoptometry.org. If you plan on practicing at a single location for more than 28 days per biennial renewal cycle, do not choose this option. Alternatively, you may choose to use your home address in lieu of a primary practice location and use your 28 fill-in days before you are required to submit a Request for Additional Practice Location)

Primary practice location address*

Street Address City State ZIP Code

Primary practice location address*

Street Address City State ZIP Code

I have included $200.00 to renew each practice location listed below for the upcoming 2-year licensing period.

I have included $200.00 to renew each practice location listed below for the upcoming 2-year licensing period.

Additional practices : If you have a primary practice location, but wish to also hold a substitute optometrist certificate, enter "substitute" in the field provided for Address below. If you merely have additional practice locations, add each of them below by clicking the "

".

Additional practice : If you have a primary practice location, but wish to also hold a substitute optometrist certificate, enter "substitute" in the field provided for Address below. If you merely have additional practice locations, add each of them below by clicking the "+".*

Address, City, Zip

Active license renewal fee

Price:

Additional practice locations fee

Price: $200.00

RENEW AN INACTIVE LICENSE

I am not currently practicing optometry in the State of Nevada. If I wish to practice in Nevada at any time during the renewal period, I recognize that I must provide the Board prior written notice of the date and location I will be practicing and submit an additional $250.00 to activate my license.

Name*

First

License Number*

Mailing Address*

Street Address City State ZIP Code

Email*

Phone

Inactive license renewal fee

Price:

Total

$0.00

Total

$0.00

By submitting this information and checking this box, I affirm that each document related to this application for renewal is complete and correct and that all information contained in this submission is true under the pains and penalties of perjury and the requirements of NRS Chapter 636 and NAC Chapter 636 and Nevada law generally. I also acknowledge that if I have directed or authorized another person to complete or submit this information on my behalf, I, the optometrist licensed by the Nevada State Board of Optometry, am fully responsible for the content of the submission. My CE, as required by Board Policy #5, has already been submitted to the Board or is being submitted with this application.*

By submitting this information and checking this box, I affirm that each document related to this application for renewal is complete and correct and that all information contained in this submission is true under the pains and penalties of perjury and the requirements of NRS Chapter 636 and NAC Chapter 636 and Nevada law generally. I also acknowledge that if I have directed or authorized another person to complete or submit this information on my behalf, I, the optometrist licensed by the Nevada State Board of Optometry, am fully responsible for the content of the submission. My CE, as required by Board Policy #5, has already been submitted to the Board or is being submitted with this application.

If you previously submitted CE’s to NSBO and received a CE Acceptance Code, please enter code or N/A.

If you previously submitted CE’s to NSBO and received a CE Acceptance Code, please enter code or N/A.

CE Acceptance Code

I authorize the preceding sum to be charged to my credit card to the account of the Nevada State Board of Optometry.*

I authorize the preceding sum to be charged to my credit card to the account of the Nevada State Board of Optometry.

Name*

First

Date*

Billing Address*

Street Address City State ZIP Code

Comments

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