MEDICARE: DR. ELIZABETH PAIGE HEDGPATH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T03287	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	410048085	OTHER		RAILROAD MEDICARE
8	P00402866	OTHER	MO	RR MEDICARE
11	410048085	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22-01220	OTHER		UNITED HEALTHCARE
2	126313	OTHER		BLUE CROSS BLUE SHIELD MO
3	U64047	OTHER		MERCY HEALTH PLANS
5	MO3287	OTHER		EYEMED
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	83962	OTHER		GROUP HEALTH PLAN
9	22933	OTHER		OPTICARE MED. COMPLETE
10	673825	OTHER		HEALHLINK
12	4181	OTHER	MO	HEALTHCARE USA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669441630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH PAIGE HEDGPATH O.D.

Provider Business Mailing Address
First Line	:	323 MONROE ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3105
Country	:	US
Telephone Number	:	573-635-1313
Fax Number	:	573-634-8500

Provider Business Practice Location Address
First Line	:	323 MONROE ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3105
Country	:	US
Telephone Number	:	573-635-1313
Fax Number	:	800-432-6004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/03/2011

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