Individual
DR. NICOLE L AMIDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
459 W JOHNSON ST, FOND DU LAC, WI 54935-3170
(920) 922-5990
Mailing address
16800 WEST CLEVELAND AVE, NEW BERLIN, WI 53151-3533
(262) 432-2005
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2758-.035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38611200
—
WI
01
—
WI2758
EYEMED VISION NO.
—
Enumeration date
04/26/2006
Last updated
12/21/2007
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