Healthcare Provider Details

I. General information

NPI: 1770725590
Provider Name (Legal Business Name): INDEPENDENCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 LYCOMING CREEK RD
WILLIAMSPORT PA
17701-1523
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 570-323-1111
  • Fax: 570-323-8805
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: INSURANCE AR
Credential:
Phone: 610-799-2020