Any optometrist who has retired as provided in 16.16.12.8 NMAC may, within five years from the date his/her license was retired, notify the board in writing of his/her desire to resume active practice. The applicant shall provide the following information.

1. A. The license number of the former license;
2. B. The applicant's full name;
3. C. The applicant's home address and phone number;
4. D. The date the applicant's license was originally issued; and

5. E. The date of the applicant's retirement.

   [8- 21-92; 6-24-94; 10-14-95; 16.16.12.10 NMAC - Rn, 16 NMAC 16.12.10, 03-15-2001]