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Northwest Eye Clinic, LLC

Ophthalmology Physician in Wayzata, 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

1891871646

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Registry record

Entity type Organization (Type 2)
Legal business name Northwest Eye Clinic, LLC
Practice address 250 Central Ave N Ste 107, Wayzata, MN, 55391
Phone (763) 416-7600
Fax (763) 416-7634
Enumeration date Oct 27, 2006
Last updated in NPPES Mar 18, 2020

Taxonomy & classification

207W00000X Ophthalmology Physician Allopathic & Osteopathic Physicians · License 360 (MN) Primary

Authorized official

Name Kelly Pettengill
Title Credentialing and Data Management
Phone (763) 416-7629

Other identifiers

Identifier Type State Issuer
607693900 Medicaid MN -

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.

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Frequently asked questions

What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.
What type of organization is Northwest Eye Clinic, LLC?
Northwest Eye Clinic, LLC is registered in NPPES as a Ophthalmology Physician (its primary provider taxonomy).

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