MEDICARE: PAIGE HEDGPATH ODPC

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		MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1013072966	OTHER	MO	MEDICARE
2	MA1757002	OTHER	MO	MEDICARE
4	1962644732	OTHER	MO	MEDICARE
5	1669530887	OTHER	MO	MEDICARE
6	MA1757	OTHER	MO	MEDICARE
7	MA1757001	OTHER	MO	MEDICARE
8	1669441630	OTHER	MO	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	14070	OTHER	MO	SPECTERA

General Provider Information

NPI Number	:	1669530887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE HEDGPATH ODPC

Provider Business Mailing Address
First Line	:	211 E BROADWAY
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6220
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:	800-432-6004

Provider Business Practice Location Address
First Line	:	1400 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1997
Country	:	US
Telephone Number	:	573-446-0331
Fax Number	:	800-432-6004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELIZABETH PAIGE HEDGPATH
Credential	:
Telephone Number	:	573-635-1313

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	04/21/2017

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Directions to “PAIGE HEDGPATH ODPC ” Practice Location

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