=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215585252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IDEAL OPTION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2019
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 THOMAS JOHNSON DR
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-5166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-522-1275
-----------------------------------------------------
Fax | 833-888-7145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 SW 7TH ST STE A205
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-2983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-522-1275
-----------------------------------------------------
Fax | 833-888-7145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | BRIAN JEFFERSON DAWSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 509-222-1275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------