Distinctive Eyewear, LLC
Distinctive Eyewear, LLC is a healthcare organization registered as Eyewear Supplier in Maple Grove, MN, holding Type 2 (organization) NPI 1043392632 since 2006. The authorized official on file is Kelly Pettengill, Credentialing and Data Management.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1043392632 |
|---|---|
| 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 | 7634167653 |
| Fax | 7634167634 |
| Enumeration date | 2006-10-20 |
| Last updated in NPPES | 2020-03-18 |
Authorized official
| Name | Kelly Pettengill |
|---|---|
| Title | Credentialing and Data Management |
| Phone | 7634167629 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 156FX1800X | Optician | Secondary | — | — |
| 332H00000X | Eyewear Supplier | Primary | — | — |
Copy-ready billing details
Provider: Distinctive Eyewear, LLC NPI: 1043392632 Taxonomy: 332H00000X (Eyewear Supplier) Address: 12000 ELM CREEK BLVD N STE 100, Maple Grove, MN, 55369
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1700864667 | Brian Hamann | Individual | Optometrist | Maple Grove, MN |
| 1063490928 | Gerald Loushin | Individual | Ophthalmology Physician | Maple Grove, MN |
| 1235117094 | Mrunalini Parvataneni | Individual | Ophthalmology Physician | Maple Grove, MN |
| 1104804962 | Janice Sinclair | Individual | Ophthalmology Physician | Maple Grove, MN |
| 1164508917 | Northwest Eye Clinic, LLC | Organization | Ophthalmology Physician | Maple Grove, MN |
| 1174799357 | Alejandra Decanini Mancera | Individual | Ophthalmology Physician | Maple Grove, MN |
| 1598092165 | Matthew Ramsey | Individual | Ophthalmology Physician | Maple Grove, MN |
| 1366000879 | Nicole Sheffer | Individual | Pediatric Optometrist | Maple Grove, MN |
Verify this record
Cross-check NPI 1043392632 against the authoritative CMS record: view Distinctive Eyewear, LLC on the official NPPES registry .
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 or validate an NPI number.
Frequently asked questions
Where is Distinctive Eyewear, LLC located?
How current is this record?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2020-03-18.