Distinctive Eyewear, LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

DISTINCTIVE EYEWEAR, LLC

Practice address

6060 Clearwater Dr Ste 150
Minnetonka, MN 55343-9490

Phone

(763) 416-7656

Fax

(763) 416-7634

NPI assigned

Oct 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Pettengill

Title

Credentialing and Data Management

Phone

(763) 416-7629

Specialties & licenses 2

Addresses

Other names 1

• Northwest Eyewear Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1104908649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 GOLDEN VALLEY RD STE 330",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274488",
            "telephone_number": "763-416-7629",
            "fax_number": "763-383-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6060 CLEARWATER DR STE 150",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439490",
            "telephone_number": "763-416-7656",
            "fax_number": "763-416-7634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTINCTIVE EYEWEAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "PETTENGILL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CREDENTIALING AND DATA MANAGEMENT",
        "authorized_official_telephone_number": "763-416-7629"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Eyewear",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northwest Eyewear",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Ann Digiacomo, APNP
• Laurel Dinnen, LGSW
• Melanie Dion, BCBA
• Keila Dipietro
• Amy Dircks, LGSW
• Sarah Dittberner, ED.S
• Suzanne Marie Ditter, PHARM D.
• Jennifer Ann Dittmar, NP-C
• Sabrina Indira Dix, NP-C
• Alexandra R Dixon

• Eyewear Supplier in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.