Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Distinctive Eyewear, LLC

Eyewear Supplier in Maple Grove, MN · enumerated 2006 · authorized official Kelly Pettengill, Credentialing and Data Management.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1043392632

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Registry record

Entity type Organization (Type 2)

Legal business name Distinctive Eyewear, LLC

Other name <Unavail>

Practice address 12000 Elm Creek Blvd N Ste 100, Maple Grove, MN, 55369

Phone (763) 416-7653

Fax (763) 416-7634

Enumeration date Oct 20, 2006

Last updated in NPPES Mar 18, 2020

Taxonomy & classification

156FX1800X Optician Eye and Vision Services Providers Secondary

332H00000X Eyewear Supplier Suppliers Primary

Authorized official

Name Kelly Pettengill

Title Credentialing and Data Management

Phone (763) 416-7629

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Where is Distinctive Eyewear, LLC located?

The practice location on file with NPPES is in Maple Grove, MN.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2020-03-18. Verify at npiregistry.cms.hhs.gov.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2020-03-18.