Basic Information
| Provider Information | |||||||||
| NPI: | 1457788275 | ||||||||
| 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: | 5094913031 | ||||||||
| Practice Location | |||||||||
| Address1: | 5615 DUNBARTON AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993018216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775221275 | ||||||||
| FaxNumber: | 5094190253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2013 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALLGAIER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER, CEO, IDEAL OPTION PLLC | ||||||||
| AuthorizedOfficialTelephone: | 5092221275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | MD00046152 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | 2083A0300X | Y | 193200000X MULTI-SPECIALTY GROUP |
ID Information
| ID | Type | State | Issuer | Description | 4243943 | 05 | MD | MEDICAID | 2031254 | 05 | WA | MEDICAID |