Mobile Optometric Office Program Information

The Mobile Optometric Office (MOO) program was established in 2020 by Assembly Bill 896 (Low, Chapter 121, Statutes of 2020) and allows nonprofits (501(c)(3)) and charitable organizations (501(c)(4)) to provide mobile optometric services to patients regardless of the patient's ability to pay under a new registration program within the Board.

Beginning in January 2025, the Board will accept applications for the MOO program. Before registering for a BreEZe account and submitting the MOO applications, please read the information on this page.

All applications must be submitted via BreEZe. The Board publishes a BreEZe informational page.

There will be three applications to complete to acquire the registration and permit to operate a MOO. Once the 4209 and 4299 applications are approved, the owner and operator via their authorized point of contact will be able to apply for a 4210 – MOO permit.

  • 4209 – Initial Registration for Ownership and Operation of a Mobile Optometric Office
  • 4299 – MOO Officer and Officials Fingerprint Application
  • 4210 – Mobile Optometric Office Permit

A fourth application will be required to comply with the quarterly or annual report requirement.

  • 4210–3010 – Quarterly or Annual Report of a Mobile Optometric Office

All applicants should read the MOO program regulations and authorizing statute prior to applying.

FAQS

1. How do I begin my application for a MOO Owner and Operator registration?

Please visit the BreEZe website and click on the "New Registration" link. Once that process is complete, apply for the 4209 Initial Registration for Ownership and Operation of a Mobile Optometric Office.

2. What information must I provide when applying for the 4209?

  • Name of Owner and Operator.
  • Primary business address, address of record, and website address for Owner and Operator.
  • Name, phone number, email address for a Point of Contact.
  • Name and license numbers of optometrists providing care.
  • Names, titles, addresses, telephone numbers, and social security numbers of elected or designated Officers and Officials.
    • Each of these individuals will need to be fingerprinted via a 4299 application.
  • Name and registration number of opticians providing care.
  • Name of unlicensed staff providing care.
  • Description of services rendered within MOO.
  • Description of how follow–up care will be provided.
  • Dates of Operation and Cities and Counties Served (if applicable).
  • Catalog of Complaints (if applicable).
  • Articles of Incorporation/Acknowledgement of Intent to Operate

3. What are the fees?

  • 4209 Owner and Operator Application fee = $360
  • 4210 Mobile Optometric Office permit = $472
  • 4209 Biennial renewal fee = $360
  • 4210 Biennial renewal fee = $472
  • 4299 Fingerprint – no application fee, but the fee for Hard Card fingerprints is $49 and for Live Scan varies.

4. How many MOO permits can an Owner and Operator have?

During the first two–year licensure period, only 12 MOO permits per owner and operator are permissible. After the first renewal there is no limit on how many MOO permits an owner and operator can have.

5. What is a Point of Contact?

The MOO program requires the Owner and Operator to provide the name and personal identifying information, including title, direct telephone number, and email address of an authorized contact person for the MOO applicant. Having only one person with which to communicate facilitates clear communication channels between the MOO and the Board. The Point of Contact is responsible for all matters related to the MOO, follow–ups, or any other Board inquiries.

6. What does "elected or designated officers and officials" mean?

The MOO regulations require the Owner and Operator to identify who the organization's officers or officials are. For many organizations, this will be the President, Vice President, Secretary, or Treasurer, but others may also be elected or designated. The applicant is to identify who these individuals are. All the identified individuals will need to create their own BreEZe account and submit a 4299 – Fingerprint Application. This is necessary to sync the fingerprint results to the 4209.

7. How does the fingerprint application process work?

Every elected or designated officer and official, as determined by the organization, must successfully pass a fingerprint background check. No 4209 application will be approved unless the identified officers/officials have passed the fingerprint background check. Fingerprints are done in one of two ways. Out of state officers/officials will do Hard Card and in–state officers/officials will do Live Scan. Hard Card requires rolling fingerprints at the local police station on a hard card we mail to the applicant. Live Scan is an electronic fingerprint process done at various providers in California. If the officers/officials of the organization already have fingerprints on file with CSBO, such as if they are all licensed optometrists, then the 4299 will not need to be done.

Hard Card fee: $49

Live Scan fee: varies, but generally $75–$125.

To request Hard Card the applicant will select that option in the 4299 application and pay the $49. Staff will mail the Hard Card to the applicant who will take it to their local police station, have their fingerprints rolled, and will mail the Hard Card back to CSBO. The Board mails the Hard Card to DOJ who processes it. From start to finish this process takes approximately 1 month.

Once fingerprint background check results for all elected or designated offices or officials are complete, staff will match the results to the 4209 application and if all other requirements are met, approve the 4209 initial registration.

**The 4299–fingerprint application and process can be done before, simultaneous too, or after the 4209 is submitted.

8. What is the Mobile Optometric Office Permit?

The 4210 is the permit specific to each mobile optometric office (vehicle). It is associated to the 4209 and each 4209 can have up to twelve MOO permits during the first renewal period. A separate permit is required for each vehicle. The 4210 permits expiration dates run concurrently with the associated 4209. The permit number must be used in all correspondence, quarterly/annual reports, or other communication with the Board. The permit numbers must also be used in advertisements to the public.

Required information to be submitted in the 4210 application:

  • Owner and Operator's legal name and certificate to operate number.
  • Name and license number of any optometrist providing services.
  • Address of record.
  • If applicable, the statement of licensure number and address.
  • Telephone number.
  • Vehicle make, model, year, and license plate/registration number.
  • Description of services to be rendered.
  • Names and license numbers for all optometrists.
  • Names and registration numbers for all opticians.
  • Names of all unlicensed persons providing patient care under BPC 2544.
  • Intended dates of operation.
  • Cities and counties served
  • Whether the MOO has the following:
    • Access ramp or lift or alternative method documented in written plan.
    • Accessible handwashing facility on the premise.
    • A means of sanitation for optometric equipment.

9. What is the quarterly/annual report and is there a template to use?

Each MOO must electronically submit a quarterly or annual report. The law authorizes during the first renewal period only for the quarterly report to be provided as an annual report each calendar year due on or before January 1.

If submitting as a quarterly report, the law requires electronic submission by the third business day of the following months and covering each quarter of operations as a registrant:

March, June, September, and December.

The quarterly report applications will open approximately 1 month prior to the due date.

Submitting the quarterly or annual report is a condition of renewal that the point of contact will attest to.

The renewal of the permit is not held up for staff to review the report.

Failure to provide the report, but attesting to having done so, would be considered unprofessional conduct and be grounds for discipline, including revocation, suspension, probation, or public reproval.

Here is a template for applicants to use: Quarterly/Annual Report Template

Required information:

Section 1 Visits:

  • MOO Office Number
  • Date of Service.
  • Organization and address serviced.
  • Description of care provided.
  • Optometrist and license number.
  • Optician and registration number.
  • Name of unlicensed persons.
  • Name, address, phone number, email address of point of contact.

Section 2 Complaints:

  • MOO Number
  • Patient name, email address, and phone number.
  • Service provided and date they were provided.
  • Organization and address serviced.
  • Service organization contact name, phone number, and email address.
  • Complaint summary and date of complaint
  • Disposition of complaint (open or resolved)
  • Follow–up provider, if any.

Section 3 Follow Up Care:

  • Updated list of licensed optometrists available for follow up care.
  • License number
  • Medi–Cal number, if applicable.

10. Are there exemptions?

Yes. The following entities are exempt from the requirement to register as an owner and operator of a mobile optometric office:

  • Optometric services provided remotely by an approved optometry school in California that meets the requirements of Section 1507 of Title 16 of the California Code of Regulations.
  • A licensee engaged in the practice of optometry at a health facility, residential care facility, or home residence, as defined in Section 3070.1.
  • A federally qualified health center, as defined in Section 1396d(l)(2)(B) of Title 42 of the United States Code.
  • A nonprofit or charitable organization exempt from taxation pursuant to Section 501(c)(3), 501(c)(4), or 501(c)(6) of the Internal Revenue Code (26 U.S.C. Sec. 501(c)(3), 501(c)(4), or 501(c)(6)), which utilizes the volunteer services of licensees engaging in the temporary practice of optometry pursuant to subdivision (b) of Section 3070. This means a licensed optometrist who works at location other than their address of record for not more than five calendar days during a 30–day period, and not more than 36 days within a calendar year.
  • A free clinic, as defined in subparagraph (B) of paragraph (1) of subdivision (a) of Section 1204 of the Health and Safety Code, which is operated by a clinic corporation, as defined in paragraph (3) of subdivision (b) of Section 1200 of the Health and Safety Code.
  • A specialized vision health care service plan, as defined in subdivision (f) of Section 1345 of the Health and Safety Code, formed and existing pursuant to the provisions of the Nonprofit Corporation Law (Division 2 (commencing with Section 5000) of Title 1 of the Corporations Code).