Organization
NORTHWEST EYE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY PETTENGILL (CREDENTIALING AND DATA MANAGEMENT)
(763) 416-7629
Entity
Organization
Contact information
Practice address
12000 ELM CREEK BLVD N STE 100, MAPLE GROVE, MN 55369-7074
(763) 416-7600
(763) 416-7634
Mailing address
8401 GOLDEN VALLEY RD STE 330, GOLDEN VALLEY, MN 55427-4488
(763) 416-7629
(763) 383-4147
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
360
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221967100
—
MN
Enumeration date
10/27/2006
Last updated
03/18/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up