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Organization
SOUTHLAKE VISION GROUP PLLC
Active
Organization
SOUTHLAKE VISION GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YURY RONIN O.D. (OPTOMETRIST)
(682) 554-2079
Entity
Organization
Contact information
Practice address
3004 E SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6618
(682) 554-2079
Mailing address
1104 GUADALUPE CT, COLLEYVILLE, TX 76034-5885
(682) 554-2079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
10/18/2017
Last updated
12/01/2017
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