Healthcare Provider Details

I. General information

NPI: 1235371683
Provider Name (Legal Business Name): INDEPENDENCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119C MAUCH CHUNK RD
COPLAY PA
18037-2106
US

IV. Provider business mailing address

4119C MAUCH CHUNK RD
COPLAY PA
18037-2106
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-2020
  • Fax: 610-799-4399
Mailing address:
  • Phone: 610-799-2020
  • Fax: 610-799-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LISA PAUSINGER
Title or Position: INS AR
Credential:
Phone: 610-799-2020