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Aesthetic Eye Pc
Specialist in Ketchum, Idaho
NPI 1881989895

Aesthetic Eye Pc is a Specialist based in Lodi, ID. Aesthetic Eye Pc practices in Ketchum, ID. The NPI Number for Aesthetic Eye Pc is 1881989895 and holds a License No. M-11139 (Idaho).

The current practice location address for Aesthetic Eye Pc is 360 E 9Th St #3, Ketchum, ID and can be reached out via phone at 541-482-2821. You can also correspond with Aesthetic Eye Pc through the mailing address at 2640 CREEKSIDE DR, LODI, CA - 95242-8341 (mailing address contact number: ).

Location: 360 E 9Th St #3, Ketchum, ID, 95242-8341
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1881989895
Provider Name
Aesthetic Eye Pc
Credential
Provider Entity Type
Organization
Address
360 E 9Th St #3, Ketchum, ID, 95242-8341
Phone Number
541-482-2821
Fax Number
Provider Enumeration Date
06/17/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1942345228 01 INDIVIDUAL NPI
M-11139 01 ID MD LICENSE
institution
Provider Business Practice Location Address Details
Address
360 E 9Th St #3
City
Ketchum
State
Idaho
Zip
83340
Phone Number
541-482-2821
Fax Number
person
Provider Business Mailing Address Details
Address
360 E 9Th St #3
City
Ketchum
State
Idaho
Zip
83340
Phone Number
541-482-2821
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
M-11139 (Idaho)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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