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NPI Code Detail

MEDICARE: IDEAL OPTION, PLLC

MEDICARE: IDEAL OPTION, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1255104527
Entity Type Code : Organization
Provider Name (Legal Business Name) : IDEAL OPTION, PLLC
Provider Business Mailing Address
First Line : 500 SW 7TH ST STE A205
Second Line :
City : RENTON
State : WA
Zip : 98057-2983
Country : US
Telephone Number : 877-522-1275
Fax Number : 833-888-7145
Provider Business Practice Location Address
First Line : 231 LYON ST SE
Second Line :
City : ALBANY
State : OR
Zip : 97321-2707
Country : US
Telephone Number : 877-522-1275
Fax Number : 833-888-7145
Authorized Official
Title or Position : CMO
Name : BRIAN JEFFERSON DAWSON
Credential :
Telephone Number : 509-222-1275
Provider Enumeration Date : 10/30/2023
Last Update Date : 04/16/2025

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