Provider Demographics
NPI:1326718339
Name:ELITE VISION GROUP, PLLC
Entity Type:Organization
Organization Name:ELITE VISION GROUP, PLLC
Other - Org Name:MASTER EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DWORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-689-9960
Mailing Address - Street 1:3451 MAYFIELD RANCH BLVD UNIT 611
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2470
Mailing Address - Country:US
Mailing Address - Phone:512-689-9960
Mailing Address - Fax:
Practice Address - Street 1:2601 S IH 35 STE C100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7336
Practice Address - Country:US
Practice Address - Phone:512-689-9960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty