# NOVA SOUTHEASTERN UNIVERSITY, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NOVA SOUHTEASTERN UNIVERSITY, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639028418
- **Legal business name:** NOVA SOUHTEASTERN UNIVERSITY, INC
- **Authorized official:** JULISSA LAZALA (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (954) 262-4946

## Contact information

- **Practice address:** 2307 W BROWARD BLVD STE 200, FORT LAUDERDALE, FL 33312-1420
- **Practice address phone:** (954) 262-4200
- **Practice address fax:** (954) 262-2269
- **Mailing address:** PO BOX 290370, FORT LAUDERDALE, FL 33329-0370
- **Mailing address phone:** (954) 262-4200
- **Mailing address fax:** (954) 262-2269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2026
- **Last updated:** 10/06/2026