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General NPI Number Information
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NPI Number | 1568366797
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Entity Type | Organization
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Legal Business Name | OPTIMA PC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 1245 NW 4TH ST STE 201
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City | REDMOND
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State | OR
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Zip | 97756-1680
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Country | US
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Telephone | 541-383-3668
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Fax | 541-383-4546
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Provider Business Mailing Address
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Address Line | 1506 NE WILLIAMSON BLVD
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City | BEND
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State | OR
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Zip | 97701-6071
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Country | US
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Telephone | 541-383-3668
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Fax | 541-383-4546
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JENNA B MACKAY
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Credential | DPM
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Telephone | 509-751-7254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State | NULL
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