Healthcare Provider Details

I. General information

NPI: 1568366797
Provider Name (Legal Business Name): OPTIMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 NW 4TH ST STE 201
REDMOND OR
97756-1680
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: 541-383-4546
Mailing address:
  • Phone: 541-383-3668
  • Fax: 541-383-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNA B MACKAY
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 509-751-7254