Southlake Vision Group PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SOUTHLAKE VISION GROUP PLLC

Practice address

3004 E Southlake Blvd
Southlake, TX 76092-6618

Phone

(682) 554-2079

NPI assigned

Oct 18, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Yury Ronin, O.D.NPI 1255696555

Title

Optometrist

Phone

(682) 554-2079

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yury Ronin, O.D.

  • Optometrist
  • Arlington, TX
  • NPI 1255696555
  Medicare reassignment NPD Authorized official
• Tami Lea Hannaman, OD

  • Optometrist
  • Southlake, TX
  • NPI 1013013051
  NPD (past)
• Dee Michel, O.D.

  • Optometrist
  • Southlake, TX
  • NPI 1528378064
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512086400000",
    "number": "1114438017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 GUADALUPE CT",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760345885",
            "telephone_number": "682-554-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 E SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926618",
            "telephone_number": "682-554-2079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE VISION GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-12-01",
        "status": "A",
        "authorized_official_last_name": "RONIN",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "682-554-2079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southlake Serenity Psychiatry
• Southlake Sleep Center, LTD
• Southlake Specialty Hospital, LLC
• Southlake Sports & Spine Rehab PLLC
• Southlake Surgery Center, LLC
• Southlake Weight Loss, LLC
• Southlake Wound Care & Hyperbarics
• Kimberly Michelle Sowell, MS PT
• David K Spady, M.D.
• Specialty Surgical Services PLLC

• All providers in Southlake, TX
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.