Distinctive Eyewear LLC

NPI #1609958230 in Wayzata, Minnesota

Provider Information

NPI Number: 1609958230
Entity Type: Organization
Organization Name: Distinctive Eyewear LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: Oct 20, 2006
Last Updated: Mar 18, 2020

Practice Location

Address: 250 CENTRAL AVE N STE 106
City: Wayzata
State: Minnesota
ZIP Code: 55391-1207
Phone: (763) 416-7654

Authorized Official

Name: KELLY PETTENGILL
Title: CREDENTIALING AND DATA MANAGEMENT
Phone: (763) 416-7629

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician/Technologist - Optician — Optician	156FX1800X
Eyewear Supplier	332H00000X	Primary

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