Healthcare Provider Details

I. General information

NPI: 1205429008
Provider Name (Legal Business Name): REBECCA FELDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA MATTESON

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 PORTLAND RD, STE 300
NEWBERG OR
97132
US

IV. Provider business mailing address

PO BOX 22009
PORTLAND OR
97269-2009
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-1341
  • Fax: 503-538-1343
Mailing address:
  • Phone: 503-558-7372
  • Fax: 503-344-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4628
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: