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Get Ca Optometry 39m-11 2012-2024

Ptometry.ca.gov Cashiering and Board Use Only OPTOMETRIST NOTIFICATION OF CHANGE OF ADDRESS FOR PLACE OF PRACTICE Receipt # Payor ID # Beneficiary ID # Amount FEE: $25 per license Instructions: This form is to be used to update the address for an optometrists license (OPT) and to obtain a renewal wall and pocket license reflecting the new address. Do not submit this form to the Board if you have made an address change via renewal of a license. Optometrists are required by law to notify th.

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