MEDICARE: PAIGE HEDGPATH OD,PC

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	TO3287	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669441630	OTHER	MO	MEDICARE
2	MA1757	OTHER	MO	MEDICARE
3	1013072966	OTHER	MO	MEDICARE
4	410048085	OTHER		RAILROAD MEDICARE
5	MA1757002	OTHER	MO	MEDICARE
6	1962644732	OTHER	MO	MEDICARE
7	1376601484	OTHER	MO	MEDICARE
8	1669530887	OTHER	MO	MEDICARE
10	MA1757001	OTHER	MO	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	1962644732	OTHER	MO	GROUP NPI

General Provider Information

NPI Number	:	1962644732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE HEDGPATH OD,PC

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	:	1709 MISSOURI BOULEVARD
Second Line	:	UNITS IJK
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3105
Country	:	US
Telephone Number	:	573-635-1313
Fax Number	:	573-634-8500

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	08/13/2024

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