Organization · Type 2 NPI

Distinctive Eyewear LLC

Eyewear Supplier · Wayzata, MN

NPI number 1609958230 Active

Practice location

250 Central Ave N Ste 106
Wayzata, MN 55391-1207

Call (763) 416-7654 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 Wayzata

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NPI record

NPI: 1609958230
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

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 1609958230

Distinctive Eyewear LLC's National Provider Identifier is 1609958230, issued on Oct 20, 2006. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Wayzata, MN. The record was last updated on Mar 18, 2020.