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NORTHWEST EYEWEAR
NPI 1043392632
Eyewear Supplier in Maple Grove, MN

Active since October 20, 2006
12000 ELM CREEK BLVD N STE 100, MAPLE GROVE, MN 55369(763) 416-7653(763) 416-7634 Get Directions Write a Review

NPPES record last updated: March 18, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Northwest Eyewear NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHWEST EYEWEAR (NPI 1043392632) is a healthcare organization registered as an eyewear supplier in Maple Grove, Minnesota and active in the NPI registry since October 2006. The organization lists Kelly Pettengill, Credentialing And Data Management, as its authorized official.

NPPES Registry Identity

NPI1043392632
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameDISTINCTIVE EYEWEAR, LLC
Location Address12000 ELM CREEK BLVD N STE 100Maple Grove, MN 55369-7074
Mailing Address8401 Golden Valley Rd Ste 330Golden Valley, MN 55427-4488 · (763) 416-7629 · Fax (763) 383-4147
Phone(763) 416-7653
Fax(763) 416-7634
Organization SubpartNo
Authorized OfficialKelly PettengillCredentialing And Data Management · (763) 416-7629
Enumeration DateOctober 20, 2006
Last NPPES UpdateMarch 18, 2020
NPPES CertifiedMarch 18, 2020
✔ NPI 1043392632 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEyewear SupplierSuppliers
Taxonomy Code332H00000X
Definition
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
Also ListedTechnician/Technologist · OpticianTaxonomy 156FX1800X
12000 ELM CREEK BLVD N STE 100, Maple Grove, MN 55369
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Other Names 1

Doing Business AsNorthwest Eyewear

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medical Equipment Supplier Medicare DMEPOS 4

Medicare supplier enrollment and the product categories Northwest Eyewear carries, from the Medicare DMEPOS supplier directory.

Northwest Eyewear

DMEPOS supplier · Maple Grove, MNOperated by Distinctive Eyewear LLC
✔

Accepts Medicare assignment

Northwest Eyewear agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20546477
Medicare Participant SinceJanuary 1, 2010
Supplier Location12000 Elm Creek Blvd N Ste 100Maple Grove, MN 55369
Phone(763) 416-7600
Supplier Specialties
Optician

Medicare Product Categories

Ocular Prostheses
Prosthetic eyes
Prosthetic Lenses: Conventional Eyeglasses
Conventional Eyeglasses
Prosthetic Lenses: Conventional Contact Lenses
Conventional Contact Lenses
Prosthetic Lenses: Prosthetics Cataract Lenses
Cataract Eyeglasses
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. GERALD P LOUSHIN MD
Ophthalmology
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
DR. JANICE M SINCLAIR MD
Ophthalmology
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
NORTHWEST EYE CLINIC, LLC
Ophthalmology
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
ALEJANDRA DECANINI MANCERA M.D.
Ophthalmology
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
DR. MRUNALINI D PARVATANENI MD
Ophthalmology
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
DR. NICOLE N SHEFFER OD
Optometrist (Pediatrics)
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
DR. MATTHEW R RAMSEY M.D.
Ophthalmology
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600
DR. BRIAN J HAMANN OD
Optometrist
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Distinctive Eyewear, LLC's NPI number?

The NPI number for Distinctive Eyewear, LLC is 1043392632. It was assigned to this organization in the NPPES registry on October 20, 2006. The provider is doing business as Northwest Eyewear.

Where is Distinctive Eyewear, LLC located?

Distinctive Eyewear, LLC is located at 12000 Elm Creek Blvd N Ste 100, Maple Grove, MN 55369. The listed phone number is (763) 416-7653.

What is Distinctive Eyewear, LLC's specialty?

The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.

Does Distinctive Eyewear, LLC accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Northwest Eyewear accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

When was this NPI record last updated?

The NPPES record for Distinctive Eyewear, LLC was last updated on March 18, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.