Southlake Vision Group PLLC
NPI 1114438017 · Optometrist · Southlake, TX
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Southlake Vision Group PLLC is a Optometrist organization in Southlake, TX (NPI 1114438017).
Provider details
- NPI number
- 1114438017
- Entity type
- Organization
- Primary specialty
- OptometristEye and Vision Services Providers
- Organization subpart
- No
- Authorized official
- Yury Ronin, Optometrist(682) 554-2079
Specialties & taxonomies
Eye and Vision Services Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2017-10-18
- Last updated
- 2017-12-01
Frequently asked questions
- What is Southlake Vision Group PLLC's NPI number?
- Southlake Vision Group PLLC's National Provider Identifier (NPI) is 1114438017, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Southlake Vision Group PLLC?
- Southlake Vision Group PLLC is classified in the NPPES registry as Optometrist (Eye and Vision Services Providers).
- Where is Southlake Vision Group PLLC located?
- Southlake Vision Group PLLC's practice location on file with NPPES is 3004 E Southlake Blvd, Southlake, TX 76092-6618.
- What is Southlake Vision Group PLLC's phone number?
- The practice phone number listed in the NPPES registry for Southlake Vision Group PLLC is (682) 554-2079.
- Does Southlake Vision Group PLLC accept Medicare?
- Southlake Vision Group PLLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Southlake Vision Group PLLC?
- The authorized official listed on Southlake Vision Group PLLC's NPPES record is Yury Ronin, Optometrist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Southlake Vision Group PLLC's NPI active?
- Yes — Southlake Vision Group PLLC's NPI (1114438017) is active in the NPPES registry as of the last update on 2017-12-01.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.