Provider Demographics
NPI:1669441630
Name:HEDGPATH, ELIZABETH PAIGE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PAIGE
Last Name:HEDGPATH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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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 1:323 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-01220OtherUNITED HEALTHCARE
126313OtherBLUE CROSS BLUE SHIELD MO
U64047OtherMERCY HEALTH PLANS
410048085OtherRAILROAD MEDICARE
MO3287OtherEYEMED
MO318612926Medicaid
83962OtherGROUP HEALTH PLAN
MOP00402866OtherRR MEDICARE
22933OtherOPTICARE MED. COMPLETE
673825OtherHEALHLINK
IL410048085OtherRR MEDICARE
MO4181OtherHEALTHCARE USA
MO318612934Medicaid
MOP00402866OtherRR MEDICARE
673825OtherHEALHLINK
83962OtherGROUP HEALTH PLAN