Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northwest Eye Clinic, LLC

Organization Ophthalmology Physician · NPI 1164508917

Northwest Eye Clinic, LLC is an Ophthalmology Physician in Maple Grove, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12000 Elm Creek Blvd N Ste 100
Maple Grove, MN 55369-7074
Phone: (763) 416-7600
Fax: (763) 416-7634
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ophthalmology Physician (primary) Taxonomy 207W00000X · Licence 360 (MN)

Record details

NPI number1164508917
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kelly Pettengill — Credentialing And Data Management · (763) 416-7629
NPI enumeratedOctober 27, 2006
Last updated in NPPESMarch 18, 2020
Certification dateMarch 18, 2020
Mailing address8401 Golden Valley Rd Ste 330, Golden Valley, MN 55427-4488

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