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General NPI Number Information
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NPI Number | 1457788275
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Entity Type | Organization
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Legal Business Name | IDEAL OPTION, PLLC
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 5615 DUNBARTON AVE
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City | PASCO
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State | WA
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Zip | 99301-8216
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Country | US
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Telephone | 877-522-1275
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Fax | 509-419-0253
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Provider Business Mailing Address
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Address Line | 500 SW 7TH ST STE A205
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City | RENTON
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State | WA
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Zip | 98057-2983
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Country | US
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Telephone | 877-522-1275
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Fax | 833-888-7145
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Authorized Official
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Title or Position | CRED MANAGER
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Name | SHANNON MARIE BOWDEN
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Credential |
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Telephone | 509-570-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD00046152
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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