Graduates of the two ACOE-accredited Canadian programs take NBEO and apply to a state board like U.S. graduates. Optometrists trained elsewhere usually need an equivalency review, often an advanced-standing program, and NBEO sponsorship from a board or accredited school if they have no accredited degree. ARBO calls board sponsorship extremely rare.
The United States has no national optometry license, so an optometrist educated outside the country applies to a state board like everyone else. What differs is the starting point. ARBO, the association of optometry licensing boards, puts it this way: "As no nationalized licensing body for Optometry exists, the process of determining the requirements to practice in the U.S. is complicated by the fact that each optometric licensing board determines its own requirements." For Canadian graduates that process looks almost like a U.S. graduate's. For everyone else it can take years.
Why are Canadian graduates treated differently?
Because most boards ask for two things: a degree from a program accredited by the Accreditation Council on Optometric Education (ACOE), and passing NBEO scores. ARBO notes that every U.S. school of optometry offers an ACOE-accredited program, "there are also 2 Canadian programs," and "There are no ACOE-accredited professional optometric degree programs outside the US and Canada." A graduate of one of those Canadian programs is an NBEO graduate candidate like any U.S. graduate and needs no sponsorship.
Canadians also make up a real share of U.S. optometry classes. ASCO's 2025-26 Annual Student Data Report found that 7.5% of 2025 graduates of U.S. schools had a permanent residence in Canada, 128 of 1,712, and that Canada was the third-largest home of enrolled students after California and Texas. Many of those graduates license in a U.S. state, a Canadian province, or both.
What do Canadian applicants run into at U.S. boards?
- Proof of status. Texas asks every applicant for proof of residency, such as a U.S. birth certificate, a REAL ID driver's license, a Permanent Resident Card or an Employment Authorization card, and says a non-citizen may need additional documentation. South Carolina's packet includes a notarized Verification of Lawful Presence, and Wyoming asks for proof of lawful presence.
- NBEO registration without a Social Security number. NBEO says applicants without a U.S. SSN call its office for an NBEO ID number and use it for every later application.
- Licenses held in Canada. Boards that want every license verified often mean every jurisdiction, not only U.S. states. Michigan asks for verification from every state or country where a license was ever held, and Idaho requires good standing in every state or country.
- Payment. New York accepts payments from outside the United States only as a check or draft on a U.S. bank in U.S. currency.
Some boards give a Canadian license weight. Virginia's endorsement rule accepts a current, active license in good standing from a U.S. jurisdiction or Canada, together with TPA qualifications and an NPDB report (18VAC105-20-11).
Did Kentucky's Canadian exam option change anything?
Only briefly. Kentucky's emergency regulation 201 KAR 5:010E let the Canadian OEBC written exam stand in for NBEO Part I, but only for tests taken or submitted between July 30, 2025 and April 15, 2026. That window has closed. NBEO has objected publicly to Kentucky's waivers, and a license issued without every NBEO part does not satisfy boards elsewhere that ask for the full series. See Kentucky's waived licenses and moving to another state.
What path does an optometrist trained outside the U.S. and Canada follow?
ARBO's guidance for internationally educated optometrists describes three steps.
1. Equivalency review
A board applied to by an internationally educated optometrist generally tries to decide whether the foreign curriculum matches an ACOE-accredited one, and may have transcripts evaluated by a North American school of optometry. If the school finds gaps, the applicant may need to enroll and complete those courses. ARBO notes that some U.S. institutions run abbreviated programs for those with advanced standing. ASCO's 2025-26 report lists graduates of foreign medical and optometry schools enrolled with advanced standing at Indiana University and SUNY, and two more schools with a policy but no such students that year.
2. NBEO, by graduation or sponsorship
After finishing an ACOE-accredited program, the candidate takes NBEO's exams like any graduate. Without one, NBEO requires sponsorship: candidates who are not students or graduates of an accredited program "must be sponsored to take the Part I ABS, Part II PAM, Part III PEPS, TMOD, ISE and LSPE, either by a state licensure board of optometry or a professional optometric degree program," with the sponsor's letter sent directly to NBEO. ARBO is blunt about the board route: "It is extremely rare to secure such sponsorship."
3. The state's own requirements
Even then, ARBO says, a board may require its own written or clinical exam, and most require a jurisprudence exam. Paperwork in another language needs care too. Illinois requires any foreign-language document to come with an original, notarized translation done by someone other than the applicant.
Which U.S. state should a Canadian graduate license in first?
The one where you will work, and then the ones with the lightest files. States that license on NBEO scores and set no years of practice, such as Texas, Illinois, New York and Pennsylvania, suit recent graduates; see states that license optometrists without years of practice. States with annual exams, such as Oklahoma, need a calendar plan. If you hold your five free NBEO score reports, pick those states at registration; after a year from graduation, every report is purchased. Our post on your first license outside your school's state covers new graduates in general.
Can a licensing service help with an international file?
With the state application, yes. We prepare the file, order verifications from every jurisdiction where you have held a license, request your NBEO score reports and NPDB self-query, and track the board; you answer and sign every application, sit every exam and handle your own immigration and work authorization. An Optometry Licensing Readiness Review is $149 and a license application on NBEO scores or by endorsement is $699 per state. See pricing or the state license index.
Common questions
- Can a Canadian optometry graduate take the NBEO exams?
- Yes. ARBO notes two Canadian programs are ACOE accredited, and NBEO treats graduates of accredited programs as graduate candidates without sponsorship.
- How does a foreign-trained optometrist qualify for NBEO?
- By graduating from an ACOE-accredited program, often through an advanced-standing track, or by sponsorship from a state optometry board or an accredited school, which ARBO calls extremely rare.
- Do I need a Social Security number to register for NBEO?
- No. NBEO says applicants without a U.S. Social Security number call its office for an NBEO ID number and use it for every application.
- Does a Canadian license count toward endorsement in the U.S.?
- In some states. Virginia's endorsement rule accepts a current, active license in good standing from a U.S. jurisdiction or Canada, with TPA qualifications and an NPDB report.
Need Help with Your Application?
We prepare the optometry licensing process end-to-end — eligibility screening, documents, board follow-ups, and tracking.