Basic Information
| Provider Information | |||||||||
| NPI: | 1669441630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEDGPATH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | PAIGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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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: | 323 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651013105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736351313 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | T03287 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 22-01220 | 01 | UNITED HEALTHCARE | OTHER | 126313 | 01 | BLUE CROSS BLUE SHIELD MO | OTHER | U64047 | 01 | MERCY HEALTH PLANS | OTHER | 410048085 | 01 | RAILROAD MEDICARE | OTHER | MO3287 | 01 | EYEMED | OTHER | 318612926 | 05 | MO | MEDICAID | 83962 | 01 | GROUP HEALTH PLAN | OTHER | P00402866 | 01 | MO | RR MEDICARE | OTHER | 22933 | 01 | OPTICARE MED. COMPLETE | OTHER | 673825 | 01 | HEALHLINK | OTHER | 410048085 | 01 | IL | RR MEDICARE | OTHER | 4181 | 01 | MO | HEALTHCARE USA | OTHER | 318612934 | 05 | MO | MEDICAID |