Nicole L Amidon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2758-.035 Issued in WI

Practice address

1595 E Sumner St Ste 108
Hartford, WI 53027-2691

Phone

(262) 709-8211

Fax

(262) 397-8610

NPI assigned

Apr 26, 2006

Last updated

Oct 15, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Nicole Lynn Boudry Former name

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

Specialty

Optometry

Education

Ferris State College - College of Optometry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Shoptikal LLC

  dba Shopko Optical 4002

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist

  Medicare reassignment Care Compare group NPD
• Shoptikal LLC

  dba Shopko Optical 4224

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1639784622

  Optometrist

  NPD
• Shoptikal LLC

  dba Fielmann Vision Care 4313

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4238

  • Eyewear Supplier
  • Hartford, WI
  • NPI 1912598830

  Optometrist

  NPD (past)
• Shoptikal LLC

  dba Shopko Optical 4219

  • Eyewear Supplier
  • Pewaukee, WI
  • NPI 1932767316

  Optometrist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1992762835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 E SUMNER ST STE 108",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272691",
            "telephone_number": "262-709-8211",
            "fax_number": "262-397-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 E SUMNER ST STE 108",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272691",
            "telephone_number": "262-709-8211",
            "fax_number": "262-397-8610"
        }
    ],
    "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": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2758-.035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BOUDRY",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Ashley M Aulenbacher, PT, DPT

• Optometrist in Hartford, WI
• Providers in Hartford, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; 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.