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NORTHWEST EYE CLINIC, LLC
NPI 1164508917
Ophthalmology in Maple Grove, MN

Active since October 27, 2006CLIA Certified · 5 labs
12000 ELM CREEK BLVD N STE 100, MAPLE GROVE, MN 55369(763) 416-7600(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.

Record update history: Mar 18, 2020, Jun 17, 2019 (2 updates tracked since 2019).

About Northwest Eye Clinic, Llc NPPES

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

NORTHWEST EYE CLINIC, LLC (NPI 1164508917) is a healthcare organization registered as an ophthalmology in Maple Grove, Minnesota and active in the NPI registry since October 2006. The organization holds 5 active CLIA laboratory certificates and lists Kelly Pettengill, Credentialing And Data Management, as its authorized official.

NPPES Registry Identity

NPI1164508917
Entity TypeOrganization
Primary Taxonomy207W00000X
Legal Business NameNORTHWEST EYE CLINIC, 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) 416-7600
Fax(763) 416-7634
Organization SubpartNo
Authorized OfficialKelly PettengillCredentialing And Data Management · (763) 416-7629
Enumeration DateOctober 27, 2006
Last NPPES UpdateMarch 18, 20202 updates tracked since enumeration
NPPES CertifiedMarch 18, 2020
✔ NPI 1164508917 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in MN · 360
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
12000 ELM CREEK BLVD N STE 100, Maple Grove, MN 55369
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Other Identifiers 1

Medicaid221967100MN

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners, Medica.Insurance ›

CLIA Laboratory Certificates CMS CLIA 5

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2122616

Northwest Eye Clinic, LLC · Maple Grove, MN
Active · expires Nov 30, 2026
CLIA Number24D2122616
Laboratory TypePhysician Office
Certificate Effective DateDecember 1, 2024
Certificate Expiration DateNovember 30, 2026
Laboratory DirectorDenise Tomniczak
Laboratory Phone(763) 416-7600
Laboratory LocationNorthwest Eye Clinic, LLC12000 Elm Creek Blvd North, Maple Grove, MN 55369
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D2104906

Northwest Eye Clinic, LLC · Golden Valley, MN
Active · expires Nov 15, 2027
CLIA Number24D2104906
Laboratory TypePhysician Office
Certificate Effective DateNovember 16, 2025
Certificate Expiration DateNovember 15, 2027
Laboratory DirectorDenise Tomniczak
Laboratory Phone(763) 416-7600
Laboratory LocationNorthwest Eye Clinic, LLC8501 Golden Valley Road Suite 100, Golden Valley, MN 55427
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D2288569

Northwest Eye Clinic, LLC · Minnetonka, MN
Active · expires Aug 27, 2027
CLIA Number24D2288569
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorDenise L. Tomniczak
Laboratory Phone(763) 416-7600
Laboratory LocationNorthwest Eye Clinic, LLC12501 Whitewater Dr Ste 110, Minnetonka, MN 55343
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D2122617

Northwest Eye Clinic, LLC · Wayzata, MN
Active · expires Nov 30, 2026
CLIA Number24D2122617
Laboratory TypePhysician Office
Certificate Effective DateDecember 1, 2024
Certificate Expiration DateNovember 30, 2026
Laboratory DirectorDenise Tomniczak
Laboratory Phone(763) 416-7600
Laboratory LocationNorthwest Eye Clinic, LLC250 Central Ave North Ste 107 & 105, Wayzata, MN 55391
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D2122618

Northwest Eye Clinic, LLC · Saint Anthony, MN
Active · expires Nov 30, 2026
CLIA Number24D2122618
Laboratory TypePhysician Office
Certificate Effective DateDecember 1, 2024
Certificate Expiration DateNovember 30, 2026
Laboratory DirectorDenise Tomniczak
Laboratory Phone(763) 416-7600
Laboratory LocationNorthwest Eye Clinic, LLC2601 39th Ave North Suite 1, Saint Anthony, MN 55421
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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.

DISTINCTIVE EYEWEAR, LLC
Eyewear Supplier
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN 55369
Hennepin County (763) 416-7653
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
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 Northwest Eye Clinic, LLC's NPI number?

The NPI number for Northwest Eye Clinic, LLC is 1164508917. It was assigned to this organization in the NPPES registry on October 27, 2006.

Where is Northwest Eye Clinic, LLC located?

Northwest Eye Clinic, LLC is located at 12000 Elm Creek Blvd N Ste 100, Maple Grove, MN 55369. The listed phone number is (763) 416-7600.

What is Northwest Eye Clinic, LLC's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Does Northwest Eye Clinic, LLC hold CLIA laboratory certificates?

Yes. 5 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Northwest Eye Clinic, LLC accept?

Health plans from HealthPartners and Medica list Northwest Eye Clinic, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northwest Eye Clinic, 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.