Distinctive Eyewear, LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

DISTINCTIVE EYEWEAR, LLC

Doing business as

Northwest Eyewear

Practice address

8501 Golden Valley Rd Ste 100
Golden Valley, MN 55427-4472

Phone

(763) 416-7655

Fax

(763) 416-7634

NPI assigned

Oct 20, 2006

Last updated

Mar 19, 2020By the provider in NPPES

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

Tax ID family

Distinctive Eyewear LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Distinctive Eyewear LLC

  dba Northwest Eyewear

  • Eyewear Supplier
  • Wayzata, MN
  • NPI 1609958230
  NPD tax ID
• Distinctive Eyewear, LLC

  dba Northwest Eyewear

  • Eyewear Supplier
  • Maple Grove, MN
  • NPI 1043392632
  NPD tax ID
• Distinctive Eyewear, LLC

  dba Northwest Eyewear

  • Optician
  • Golden Valley, MN
  • NPI 1457690133
  NPD tax ID
• Distinctive Eyewear, LLC

  dba Northwest Eyewear

  • Eyewear Supplier
  • St Anthony, MN
  • NPI 1548342124
  NPD tax ID

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1154403723",
    "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": "8501 GOLDEN VALLEY RD STE 100",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274472",
            "telephone_number": "763-416-7655",
            "fax_number": "763-416-7634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Central Ave N Ste 106",
            "address_purpose": "LOCATION",
            "city": "Wayzata",
            "state": "MN",
            "postal_code": "553911207",
            "country_code": "US",
            "telephone_number": "763-416-7654",
            "fax_number": "763-416-7634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 39th Ave NE Ste 1",
            "address_purpose": "LOCATION",
            "city": "St. Anthony",
            "state": "MN",
            "postal_code": "55421",
            "country_code": "US",
            "telephone_number": "763-416-7674",
            "fax_number": "763-416-7634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6060 Clearwater Dr Ste 150",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553439490",
            "country_code": "US",
            "telephone_number": "763-416-7656",
            "fax_number": "763-416-7634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12000 Elm Creek Blvd N Ste 100",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553697074",
            "country_code": "US",
            "telephone_number": "763-416-7653",
            "fax_number": "763-416-7634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DISTINCTIVE EYEWEAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "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": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Eyewear",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northwest Eyewear",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Kent Dickson, RPH
• Lori Dickson, RPH
• Benjamin Alan Dingman
• Fartun Dirie
• Angela Dawn Dirks, LPCC, ATR
• Distinctive Eyewear, LLC (Northwest Eyewear)
• Diversity Wellness Center LLC
• DMD Enterprises LLC
• Dodson Directive, P.a.
• Luke Dolezal, M.D.

• Eyewear Supplier in Golden Valley, MN
• Providers in Golden Valley, 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 19, 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.