Distinctive Eyewear LLC
NPI 1609958230 · Eyewear Supplier · Wayzata, 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 Wayzata, MN (NPI 1609958230).
Provider details
- NPI number
- 1609958230
- 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
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 1609958230, 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 250 Central Ave N Ste 106, Wayzata, MN 55391-1207.
- What is Distinctive Eyewear LLC's phone number?
- The practice phone number listed in the NPPES registry for Distinctive Eyewear LLC is (763) 416-7654.
- 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 and 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 (1609958230) 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.