NPI 1043392632

Distinctive Eyewear, LLC

Organisation Eyewear Supplier Maple Grove, MN

Practice location

Address: 12000 Elm Creek Blvd N STE 100, Maple Grove, MN 55369-7074
Phone: (763) 416-7653
Fax: (763) 416-7634
Mailing address: 8401 Golden Valley Rd STE 330, Golden Valley, MN 55427-4488

Authorised official

Name: Kelly Pettengill
Title: Credentialing and Data Management
Phone: (763) 416-7629

Registered specialties (2)

Eyewear Supplier Primary

Suppliers Taxonomy 332H00000X

Other Eyewear Supplier providers in Minnesota →

Optician

Eye and Vision Services Providers Taxonomy 156FX1800X

Other Technician/Technologist providers in Minnesota →

Registry record

NPI: 1043392632
Entity type: Organization
NPI issued: 20 Oct 2006
Record last updated: 18 Mar 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.