Provider Demographics
NPI:1831714120
Name:AVGOULAS, NICOLE SHIRLEY (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SHIRLEY
Last Name:AVGOULAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:W248N5233 EXECUTIVE DR UNIT 200
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-4318
Mailing Address - Country:US
Mailing Address - Phone:262-304-0080
Mailing Address - Fax:
Practice Address - Street 1:W248N5233 EXECUTIVE DR UNIT 200
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-4318
Practice Address - Country:US
Practice Address - Phone:262-304-0080
Practice Address - Fax:262-304-0080
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3617-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist