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General NPI Number Information
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NPI Number | 1639526569
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Entity Type | Organization
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Legal Business Name | IDEAL OPTION LAB
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 8508 W GAGE BLVD STE A101
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City | KENNEWICK
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State | WA
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Zip | 99336-8106
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Country | US
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Telephone | 509-222-1275
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Fax | 833-888-7145
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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 | CMO
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Name | BRIAN JEFFERSON DAWSON
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Credential | MD
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Telephone | 509-222-1275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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