Provider Demographics
NPI:1376601484
Name:PAIGE HEDGPATH O.D,P.C.
Entity Type:Organization
Organization Name:PAIGE HEDGPATH O.D,P.C.
Other - Org Name:EYES ON MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-407-2696
Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:323 MONROE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3105
Practice Address - Country:US
Practice Address - Phone:573-635-1313
Practice Address - Fax:800-432-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013072966OtherMEDICARE
MO1669441630OtherMEDICARE
MOMA1757001OtherMEDICARE
MOMA1757OtherMEDICARE
14072OtherSPECTERA
MOMA1757002OtherMEDICARE
MO1376601484OtherMEDICARE
MO1962644732OtherMEDICARE
14072OtherSPECTERA
MOMA1757OtherMEDICARE