Provider Demographics
NPI:1770693079
Name:DR. SHAJIDA ESPAT REICH & ASSOCIATES PC
Entity type:Organization
Organization Name:DR. SHAJIDA ESPAT REICH & ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA-SHAJIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPAT - REICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-779-9851
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:OR
Mailing Address - Zip Code:97533-0152
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2640AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR091001-01OtherPACIFICSOURCE GROUP ID#
OR156780OtherCOLE MANAGED VISION GRP#
OR12682OtherSPECTERA GROUP #
OK205038OtherCOLE VISION INDIVIDUAL#
OR213444Medicaid
OR111673OtherPROVIDENCE PREFERRED
OR212350OtherMED EYE OF OR GRP#
OR7649OtherMES GROUP #
OR150518Medicaid
OR400255602OtherPREFERRED CHOICE 65 GRP #
OR4L283OtherLIFEWISE GRP #
ORU67514Medicare UPIN
OR150518Medicaid