OrganizationActive
Northwest Eye Clinic, LLC
NPI 1164508917 · Ophthalmology Physician · Maple Grove, MN
Provider details
- NPI number
- 1164508917
- Entity type
- Organization
- Primary specialty
- Ophthalmology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kelly Pettengill, Credentialing and Data Management(763) 416-7629
- License
- 360 (MN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
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
12000 Elm Creek Blvd N Ste 100
Maple Grove, MN 55369-7074
Phone: (763) 416-7600
Fax: (763) 416-7634
Street-level locationGet directions
Mailing address
8401 Golden Valley Rd Ste 330
Golden Valley, MN 55427-4488
Registry dates
- Enumerated
- 2006-10-27
- 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.