Basic Information
| Provider Information | |||||||||
| NPI: | 1184378887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IDEAL OPTION, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5615 DUNBARTON AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993018216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092221275 | ||||||||
| FaxNumber: | 8338887145 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 4TH ST N | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | MT | ||||||||
| PostalCode: | 592301857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775221275 | ||||||||
| FaxNumber: | 8338887145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2022 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOWDEN | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTING & CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5095709302 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.