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
1	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1487001475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL OPTION, PLLC

Provider Business Mailing Address
First Line	:	8656 W GAGE BLVD
Second Line	:	SUITE 301B
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7145
Country	:	US
Telephone Number	:	509-222-1275
Fax Number	:	509-491-3031

Provider Business Practice Location Address
First Line	:	1601 2ND AVE N STE 300W
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3243
Country	:	US
Telephone Number	:	509-222-1275
Fax Number	:	509-491-3031

Authorized Official
Title or Position	:	CMO
Name	:	BRIAN JEFFERSON DAWSON
Credential	:	MD
Telephone Number	:	509-222-1275

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	08/30/2023

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Directions to “IDEAL OPTION, PLLC ” Practice Location

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