Organization · Type 2 NPI

Distinctive Eyewear, LLC

Eyewear Supplier · Maple Grove, MN

NPI number 1043392632 Active

Practice location

12000 Elm Creek Blvd N Ste 100
Maple Grove, MN 55369-7074

Call (763) 416-7653 Map

Fax (763) 416-7634

Mailing address

8401 Golden Valley Rd Ste 330
Golden Valley, MN 55427-4488

Specialties and licenses

Taxonomy	Code	License
Optician	156FX1800X	None listed
Eyewear Supplier Primary	332H00000X	None listed

Eyewear Supplier: An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

9 other providers at this address

Other eyewear supplier providers in Maple Grove

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NPI record

NPI: 1043392632
Entity type: Organization (Type 2)
Issued: Oct 20, 2006
Last updated: Mar 18, 2020
Status: Active

Other names

<unavail>
Northwest Eyewear · doing business as
Northwest Eyewear · doing business as

Authorized official

Kelly Pettengill
Credentialing and Data Management
(763) 416-7629

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1043392632

Distinctive Eyewear, LLC's National Provider Identifier is 1043392632, issued on Oct 20, 2006. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Maple Grove, MN. The record was last updated on Mar 18, 2020.