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Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC
Authorized official
DR. ROSEMERY ESTEVEZ (CONTRACTING DIRECTOR)
(954) 262-4343
Entity
Organization
Contact information
Practice address
650 NORTH ANDREWS AVENUE, FT. LAUDERDALE, FL 33311-7436
(954) 262-4100
(954) 262-6888
Mailing address
PO BOX 290370, DAVIE, FL 33329-0370
(954) 262-4397
(954) 262-2269
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
NULL
152W00000X
Optometrist
Primary
—
—
156FX1800X
Optician
—
NULL
156FX1800X
Optician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078488503
—
FL
01
—
98673
MEDICARE
FL
Enumeration date
02/02/2007
Last updated
02/19/2024
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