Organization · Type 2 NPI

Distinctive Eyewear, LLC

Eyewear Supplier · St. Anthony, MN

NPI number 1548342124 Active

Practice location

2601 39th Ave NE
St. Anthony, MN 55421

Call (763) 416-7674 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.

Other eyewear supplier providers in St. Anthony

Northwest Eye Clinic, LLCEyewear Supplier St. Anthony, MN NPI 1720982010

See all in St. Anthony →

NPI record

NPI: 1548342124
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 & Data Management
(763) 416-7629

Verify this record

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 1548342124

Distinctive Eyewear, LLC's National Provider Identifier is 1548342124, issued on Oct 20, 2006. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in St. Anthony, MN. The record was last updated on Mar 18, 2020.