Provider Demographics
NPI:1154668465
Name:PAIGE HEDGPATH OD, PC
Entity Type:Organization
Organization Name:PAIGE HEDGPATH OD, PC
Other - Org Name:EYES ON MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEDGPATH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-635-1313
Mailing Address - Street 1:323 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3105
Mailing Address - Country:US
Mailing Address - Phone:573-635-1313
Mailing Address - Fax:573-634-8500
Practice Address - Street 1:4645G OSAGE BEACH PARKWAY
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-635-1313
Practice Address - Fax:573-634-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty