Provider Demographics
NPI:1972549657
Name:INDEPENDENCE CORPORATION
Entity type:Organization
Organization Name:INDEPENDENCE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-799-2020
Mailing Address - Street 1:4119 MAUCH CHUNK RD # C
Mailing Address - Street 2:
Mailing Address - City:COPLAY
Mailing Address - State:PA
Mailing Address - Zip Code:18037-2106
Mailing Address - Country:US
Mailing Address - Phone:610-799-2020
Mailing Address - Fax:610-799-4399
Practice Address - Street 1:2274 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-4522
Practice Address - Country:US
Practice Address - Phone:610-432-3937
Practice Address - Fax:610-432-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018518950002Medicaid
PA128156Medicare PIN
PA0830100001Medicare NSC