Basic Information
| Provider Information | |||||||||
| NPI: | 1548798879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IDEAL OPTION, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8514 W GAGE BLVD STE G | ||||||||
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| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993368108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092221275 | ||||||||
| FaxNumber: | 5094913031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 CLEVELAND BLVD BLDG A | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836050718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092221275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2017 | ||||||||
| LastUpdateDate: | 01/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | ALLGAIER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5092221275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RA0401X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 261Q00000X | ID | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 1457788275 | 05 | ID | MEDICAID |