# AESTHETIC EYE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881989895
- **Authorized official:** ALAN W MCINNES JR. MD (PRESIDENT)
- **Authorized official phone:** (209) 981-2747

## Contact information

- **Practice address:** 360 E 9TH ST \#3, KETCHUM, ID 83340
- **Practice address phone:** (541) 482-2821
- **Mailing address:** 2640 CREEKSIDE DR, LODI, CA 95242-8341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M-11139 | ID | Yes |

## Other

- **Enumeration date:** 06/17/2011
- **Last updated:** 06/17/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1942345228 | INDIVIDUAL NPI | — |
| 01 | — | M-11139 | MD LICENSE | ID |