Get Optometry Ancillary Location Registration - Illinois Department Of - Ioaweb

Filling out the Optometry Ancillary Location Registration form is an essential step for optometrists to register their ancillary locations in Illinois. This guide will provide you with clear, step-by-step instructions to complete the form online effectively.

Follow the steps to complete your registration form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor for editing.
2. Begin by entering the name of the optometrist in the designated field. This should include the full name as it appears on the Illinois license.
3. Provide the Illinois license number in the specified section. Ensure the number is accurate to avoid processing delays.
4. Fill in the address of record, including the street address, city, and zip code in the appropriate fields.
5. List the first ancillary location if applicable. Input the name of the facility, the complete street address, city, and zip code, along with the contact telephone number.
6. Complete the section for the second ancillary location in the same manner, ensuring all information matches the records.
7. Continue with the third and fourth locations, repeating the process of entering all required details for each facility.
8. After all locations are entered, review the information for accuracy to ensure there are no mistakes.
9. Once you have verified that all information is correct, save the changes made to the form.
10. Download, print, or share the completed registration form as needed, then submit it following the instructions provided.

Complete your registration document online today for efficient processing!