Basic Information
| Provider Information | |||||||||
| NPI: | 1154668465 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAIGE HEDGPATH OD, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EYES ON MISSOURI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651013105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736351313 | ||||||||
| FaxNumber: | 5736348500 | ||||||||
| Practice Location | |||||||||
| Address1: | 4645G OSAGE BEACH PARKWAY | ||||||||
| Address2: | |||||||||
| City: | OSAGE BEACH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736351313 | ||||||||
| FaxNumber: | 5736348500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2013 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | HEDGPATH | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5736351313 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TO3287 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.