Healthcare Provider Details

I. General information

NPI: 1144745738
Provider Name (Legal Business Name): IDEAL OPTION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E 42ND AVE STE 306
ANCHORAGE AK
99508-5228
US

IV. Provider business mailing address

8514 W GAGE BLVD STE G
KENNEWICK WA
99336-8108
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 509-491-3031
Mailing address:
  • Phone: 877-222-1275
  • Fax: 509-491-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN JEFFERSON DAWSON
Title or Position: CMO
Credential: MD
Phone: 509-222-1275