1770693079 NPI number — DR. SHAJIDA ESPAT REICH & ASSOCIATES PC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770693079 NPI number — DR. SHAJIDA ESPAT REICH & ASSOCIATES PC

Employer Identification Number (EIN):

Provider Organization Name:

DR. SHAJIDA ESPAT REICH & ASSOCIATES PC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

MASTER EYE ASSOCIATES

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1770693079

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/11/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 152

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MURPHY

Provider Business Mailing Address State Name:

OR

Provider Business Mailing Address Postal Code:

97533-0152

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

541-779-9851

Provider Business Mailing Address Fax Number:

541-779-9853

Provider First Line Business Practice Location Address:

55 E STEWART AVE STE B

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MEDFORD

Provider Business Practice Location Address State Name:

OR

Provider Business Practice Location Address Postal Code:

97501-7944

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

541-779-9851

Provider Business Practice Location Address Fax Number:

541-779-9853

Provider Enumeration Date:

08/30/2006

Authorized Official Last Name:

ESPAT - REICH

Authorized Official First Name:

MARIA-SHAJIDA

Authorized Official Middle Name:

Authorized Official Title or Position:

PHYSICIAN OWNER

Authorized Official Telephone Number:

541-779-9851

• Taxonomy code: 152W00000X , with the licence number:  2640AT , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 091001-01 . This is a "PACIFICSOURCE GROUP ID#" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 156780 . This is a "COLE MANAGED VISION GRP#" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 12682 . This is a "SPECTERA GROUP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 205038 . This is a "COLE VISION INDIVIDUAL#" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: 213444 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
• Identifier: 111673 . This is a "PROVIDENCE PREFERRED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 212350 . This is a "MED EYE OF OR GRP#" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 7649 . This is a "MES GROUP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 150518 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
• Identifier: 400255602 . This is a "PREFERRED CHOICE 65 GRP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 4L283 . This is a "LIFEWISE GRP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".