Healthcare Provider Details

I. General information

NPI: 1972549657
Provider Name (Legal Business Name): INDEPENDENCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 MACARTHUR RD
WHITEHALL PA
18052-4522
US

IV. Provider business mailing address

4119 MAUCH CHUNK RD # C
COPLAY PA
18037-2106
US

V. Phone/Fax

Practice location:
  • Phone: 610-432-3937
  • Fax: 610-432-0124
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: MRS. LISA A PAUSINGER
Title or Position: INSURANCE ADMIN
Credential:
Phone: 610-799-2020