Provider Demographics
NPI:1619357845
Name:INDEPENDENCE CORPORATION
Entity Type:Organization
Organization Name:INDEPENDENCE CORPORATION
Other - Org Name:EYELAND OPTICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
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:717-492-4578
Mailing Address - Fax:717-928-4170
Practice Address - Street 1:769 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-9510
Practice Address - Country:US
Practice Address - Phone:610-799-2020
Practice Address - Fax:610-766-4399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENCE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA128156Medicare PIN