Provider Demographics
NPI:1952851800
Name:IDEAL OPTION, PLLC
Entity Type:Organization
Organization Name:IDEAL OPTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-222-1275
Mailing Address - Street 1:8656 W GAGE BLVD
Mailing Address - Street 2:SUITE 301B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7145
Mailing Address - Country:US
Mailing Address - Phone:509-222-1275
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:506 N 40TH AVE
Practice Address - Street 2:STE 201
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4318
Practice Address - Country:US
Practice Address - Phone:509-895-7740
Practice Address - Fax:509-895-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031254Medicaid
WA2031254Medicaid