Healthcare Provider Details

I. General information

NPI: 1811813488
Provider Name (Legal Business Name): OPTIMA FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 NE WILLIAMSON BLVD
BEND OR
97701-6071
US

IV. Provider business mailing address

1506 NE WILLIAMSON BLVD
BEND OR
97701-6071
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-3668
  • Fax:
Mailing address:
  • Phone: 541-383-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNA MACKAY
Title or Position: PODIATRIST
Credential: DPM
Phone: 541-383-3668