Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southlake Vision Group PLLC

Organization Optometrist · NPI 1114438017

Southlake Vision Group PLLC is an Optometrist in Southlake, Texas. Registered with an NPI since 2017.

In the registry since
2017
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3004 E Southlake Blvd
Southlake, TX 76092-6618
Phone: (682) 554-2079
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X

Record details

NPI number1114438017
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Yury Ronin — Optometrist · (682) 554-2079
NPI enumeratedOctober 18, 2017
Last updated in NPPESDecember 1, 2017
Mailing address1104 Guadalupe Ct, Colleyville, TX 76034-5885

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