Provider Demographics
NPI:1164415295
Name:ESPAT REICH, MARIA SHAJIDA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA SHAJIDA
Middle Name:
Last Name:ESPAT REICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E STEWART AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7944
Mailing Address - Country:US
Mailing Address - Phone:541-779-9851
Mailing Address - Fax:541-779-9853
Practice Address - Street 1:55 E STEWART AVE STE B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7944
Practice Address - Country:US
Practice Address - Phone:541-779-9851
Practice Address - Fax:541-779-9853
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2640AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
205038OtherCOLE MANAGED VISION
111673OtherPROVIDENCE PREFERRED
410048870OtherRR MEDICARE
OR150518Medicaid
150518OtherOMAP PROVIDER ID#
111673OtherPROVIDENCE PREFERRED
150518OtherOMAP PROVIDER ID#