Organization
AESTHETIC EYE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN W MCINNES JR. MD (PRESIDENT)
(209) 981-2747
Entity
Organization
Contact information
Practice address
360 E 9TH ST #3, KETCHUM, ID 83340
(541) 482-2821
Mailing address
2640 CREEKSIDE DR, LODI, CA 95242-8341
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M-11139
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942345228
INDIVIDUAL NPI
—
01
—
M-11139
MD LICENSE
ID
Enumeration date
06/17/2011
Last updated
06/17/2011
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