SOUTHLAKE VISION GROUP PLLC
NPI 1114438017
Optometrist in Southlake, TX

Q: What is Southlake Vision Group PLLC's NPI number?

The NPI number for Southlake Vision Group PLLC is 1114438017. It was assigned to this organization in the NPPES registry on October 18, 2017.

Q: What is Southlake Vision Group PLLC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Active since October 18, 2017

3004 E SOUTHLAKE BLVD, SOUTHLAKE, TX 76092(682) 554-2079 Get Directions Write a Review

NPPES record last updated: December 1, 2017. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 1, 2017, Oct 18, 2017 (2 updates tracked since 2017).

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About Southlake Vision Group Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHLAKE VISION GROUP PLLC (NPI 1114438017) is a healthcare organization registered as an optometrist in Southlake, Texas and active in the NPI registry since October 2017. The organization lists Yury Ronin, Optometrist, as its authorized official.

NPPES Registry Identity

NPI1114438017

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameSOUTHLAKE VISION GROUP PLLC

Location Address3004 E SOUTHLAKE BLVDSouthlake, TX 76092-6618

Mailing Address1104 Guadalupe CtColleyville, TX 76034-5885 · (682) 554-2079

Phone(682) 554-2079

Organization SubpartNo

Authorized OfficialYury RoninOptometrist · (682) 554-2079

Enumeration DateOctober 18, 2017

Last NPPES UpdateDecember 1, 20172 updates tracked since enumeration

✔ NPI 1114438017 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

3004 E SOUTHLAKE BLVD, Southlake, TX 76092

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southlake Vision Group Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southlake Vision Group PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Yury Ronin, O.D.

Optometry

NPI 1255696555

350 E INTERSTATE 20
Arlington, TX 76018

(817) 784-0222

✔ PECOS✔ Accepts Medicare18 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southlake Vision Group PLLC's NPI number?

The NPI number for Southlake Vision Group PLLC is 1114438017. It was assigned to this organization in the NPPES registry on October 18, 2017.

Where is Southlake Vision Group PLLC located?

Southlake Vision Group PLLC is located at 3004 E Southlake Blvd, Southlake, TX 76092. The listed phone number is (682) 554-2079.

What is Southlake Vision Group PLLC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Southlake Vision Group PLLC enrolled in Medicare?

Yes. Southlake Vision Group PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southlake Vision Group PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Southlake Vision Group PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Southlake Vision Group PLLC accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 7 other insurers list Southlake Vision Group PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southlake Vision Group PLLC was last updated on December 1, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.