| Organization Name: | DISTINCTIVE EYEWEAR LLC |
| NPI Number: | 1043392632 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AUDREY IRENE BERG (BUSINESS OFFICE SUPERVISOR) |
| Mailing Address: | 12000 Elm Creek Blvd N Suite 100 Maple Grove |
| State: | MN US |
| Postal Code: | 553697073 |
| Phone Number: | 7634167600 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2006 |
| NPI Last Update Date: | 05/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |