MEDICARE: INDEPENDENCE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508008376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE CORPORATION

Provider Business Mailing Address
First Line	:	4119 MAUCH CHUNK RD # C
Second Line	:
City	:	COPLAY
State	:	PA
Zip	:	18037-2106
Country	:	US
Telephone Number	:	610-799-2020
Fax Number	:	610-799-4399

Provider Business Practice Location Address
First Line	:	578 SUSQUEHANNA BLVD
Second Line	:
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-3233
Country	:	US
Telephone Number	:	570-459-2200
Fax Number	:	570-459-8690

Authorized Official
Title or Position	:	INS AR
Name	:	LISA PAUSINGER
Credential	:
Telephone Number	:	610-799-2020

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	12/06/2013

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Directions to “INDEPENDENCE CORPORATION ” Practice Location

Language	Start Address	Practice Location

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