Northwest Eye Clinic, LLC
NPI 1255417002 · Ophthalmology Physician · St. Anthony, MN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Northwest Eye Clinic, LLC is a Ophthalmology Physician organization in St. Anthony, MN (NPI 1255417002).
Provider details
- NPI number
- 1255417002
- 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
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
Mailing address
Registry dates
- Enumerated
- 2006-10-27
- Last updated
- 2020-03-18
- Certified
- 2020-03-18
Frequently asked questions
- What is Northwest Eye Clinic, LLC's NPI number?
- Northwest Eye Clinic, LLC's National Provider Identifier (NPI) is 1255417002, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Northwest Eye Clinic, LLC?
- Northwest Eye Clinic, LLC is classified in the NPPES registry as Ophthalmology Physician (Allopathic & Osteopathic Physicians).
- Where is Northwest Eye Clinic, LLC located?
- Northwest Eye Clinic, LLC's practice location on file with NPPES is 2601 39th Ave Ne Ste 1, St. Anthony, MN 55421.
- What is Northwest Eye Clinic, LLC's phone number?
- The practice phone number listed in the NPPES registry for Northwest Eye Clinic, LLC is (763) 416-7600.
- Does Northwest Eye Clinic, LLC accept Medicare?
- Northwest Eye Clinic, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Northwest Eye Clinic, LLC?
- The authorized official listed on Northwest Eye Clinic, LLC's NPPES record is Kelly Pettengill, Credentialing and Data Management. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Northwest Eye Clinic, LLC's NPI active?
- Yes — Northwest Eye Clinic, LLC's NPI (1255417002) is active in the NPPES registry as of the last update on 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.