Nicole L Amidon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2758-.035 Issued in WI

Practice address

459 W Johnson St
Fond Du Lac, WI 54935-3170

Phone

(920) 922-5990

NPI assigned

Apr 26, 2006

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shoptikal LLC

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist, WI

  Medicare reassignment Care Compare group NPD
• Shoptikal LLC

  • Eyewear Supplier
  • Coeur D Alene, ID
  • NPI 1063078442
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Spokane, WA
  • NPI 1154987535
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • West Jordan, UT
  • NPI 1407412885
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Missoula, MT
  • NPI 1417513896
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Bismarck, ND
  • NPI 1518601483
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Marquette, MI
  • NPI 1578129094
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Aberdeen, SD
  • NPI 1588220958
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Dubuque, IA
  • NPI 1588220974
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Dixon, IL
  • NPI 1699331082
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Saint Cloud, MN
  • NPI 1942866371
  Care Compare group
• Shoptikal LLC

  • Eyewear Supplier
  • Grand Island, NE
  • NPI 1952967325
  Care Compare group

Specialty

Optometry

Education

Ferris State College - College of Optometry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoptikal LLC 192 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

• Miss Nicole Lynn Boudry Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 21, 2007.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198195200000",
    "number": "1992762835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16800 WEST CLEVELAND AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531513533",
            "telephone_number": "262-432-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 W JOHNSON ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353170",
            "telephone_number": "920-922-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMIDON",
        "first_name": "NICOLE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2007-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2758-.035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED VISION NO.",
            "identifier": "WI2758",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38611200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BOUDRY",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alicia Hans LCSW
• Jennifer B Alizadeh, PT
• Reem Aljamaan, BDS, DDS, CAGS, MSD
• Allay Home and Hospice, Inc.
• Desirae Nichole Alsum
• Anchor Point Home Health Services
• Anderson Chiropractic Office LLC
• Brianna L Anderson, AUD
• Deborah A Anderson, PT CEES
• Jan Andrews, RN

• All providers in Fond Du Lac, WI
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.