Distinctive Eyewear, LLC
NPI 1548342124 · Eyewear Supplier · St. Anthony, MN
Enrolled with Medicare as Dme Supplier - Optician · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Distinctive Eyewear, LLC is a Eyewear Supplier organization in St. Anthony, MN (NPI 1548342124).
Provider details
- NPI number
- 1548342124
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Kelly Pettengill, Credentialing & Data Management(763) 416-7629
Specialties & taxonomies
Suppliers
- Optician156FX1800X
Eye and Vision Services Providers
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
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
Frequently asked questions
- What is Distinctive Eyewear, LLC's NPI number?
- Distinctive Eyewear, LLC's National Provider Identifier (NPI) is 1548342124, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Distinctive Eyewear, LLC?
- Distinctive Eyewear, LLC is classified in the NPPES registry as Eyewear Supplier (Suppliers).
- Where is Distinctive Eyewear, LLC located?
- Distinctive Eyewear, LLC's practice location on file with NPPES is 2601 39th Ave Ne, St. Anthony, MN 55421.
- What is Distinctive Eyewear, LLC's phone number?
- The practice phone number listed in the NPPES registry for Distinctive Eyewear, LLC is (763) 416-7674.
- Does Distinctive Eyewear, LLC accept Medicare?
- Distinctive Eyewear, 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 Distinctive Eyewear, LLC?
- The authorized official listed on Distinctive Eyewear, LLC's NPPES record is Kelly Pettengill, Credentialing & Data Management. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Distinctive Eyewear, LLC's NPI active?
- Yes — Distinctive Eyewear, LLC's NPI (1548342124) 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.