Optometry practice sales are usually negotiated on financials — a multiple of earnings or revenue — but the financials only describe the past. Whether the practice still produces those numbers in year two depends on operational assets that never appear cleanly on a P&L: the recall system, the payer relationships, the charts, and the people. That's where diligence earns its keep, in both directions — buyers protecting the purchase, sellers proving the premium. (Valuation mechanics and deal terms belong with your accountant and attorney; what follows is the operational layer that informs them.)
The recall list is the revenue engine — audit it
A practice's future schedule lives in its recall integrity. Pull the numbers: what share of active patients (seen within 24 months) hold a future appointment or an active recall entry? How did recall fulfillment trend over the trailing three years? A practice with 3,000 charts and a dead recall system is a marketing project wearing a practice's clothes; one with 1,800 charts and 80% recall fulfillment is a machine. Cross-check retention by cohort — a graying, shrinking panel and a growing family panel command different futures at the same revenue.
Payer mix and transferability
Map revenue by payer: vision plans, medical insurance, self-pay, and the profitability of each. Then check transferability — which panels are open in this market, how long credentialing takes, and whether any revenue depends on relationships (a nursing-home contract, an employer group) that follow the seller personally. A heavy medical-model book is generally the most durable revenue in optometry; a practice dependent on one closed vision panel deserves a harder look.
Charts, equipment, and the quiet liabilities
Sample fifty charts: documentation quality, current prescriptions, recall entries, and whether the EHR data will actually migrate. Inventory the equipment with ages and service contracts — an aging OCT and field unit is a six-figure capital need hiding in a photo of a nice exam lane. Review the lease with the same seriousness as the practice itself: term remaining, assignment rights, and renewal terms sink more deals than price does. And reconcile optical inventory at cost with an aging report — a board full of five-year-old frames is not an asset.
The people are half the practice
Staff tenure, wages against market, and who holds the undocumented knowledge — the optician who knows every patient, the biller who knows every payer quirk. Buyers should price the risk of key departures; sellers should shore up documentation and cross-training before listing, because a practice that runs on written systems instead of memories is demonstrably worth more.
Sellers: diligence yourself two years early
Every weakness above is fixable ahead of a sale — rebuild recall, document workflows, clean the charts, refresh the board. Much of that preparation is systematic administrative work an eye care virtual assistant can run at a flat $10/hour: recall rebuilds, chart audits, inventory reconciliation, procedure documentation. The same discipline applies across eye care — ophthalmology groups sell on identical fundamentals with bigger numbers. Practices aren't valued on what they earned; they're valued on what a buyer believes they'll keep earning. Make that belief easy to hold.
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