OrganizationActive
Distinctive Eyewear, LLC
NPI 1104908649 · Eyewear Supplier · Minnetonka, MN
Provider details
- NPI number
- 1104908649
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Kelly Pettengill, Credentialing and Data Management(763) 416-7629
Specialties & taxonomies
Suppliers
- Optician156FX1800X
Eye and Vision Services Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
6060 Clearwater Dr Ste 150
Minnetonka, MN 55343-9490
Phone: (763) 416-7656
Fax: (763) 416-7634
Street-level locationGet directions
Mailing address
8401 Golden Valley Rd Ste 330
Golden Valley, MN 55427-4488
Other names (DBA / former)
- Doing business as
- Northwest Eyewear
- Doing business as
- Northwest Eyewear
Registry dates
- Enumerated
- 2006-10-20
- Last updated
- 2020-03-18
- Certified
- 2020-03-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.