# NOVA SOUTHEASTERN UNIVERSITY, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1700924511
- **Legal business name:** NOVA SOUTHEASTERN UNIVERSITY, INC
- **Authorized official:** DR. ROSEMERY ESTEVEZ (CONTRACTING DIRECTOR)
- **Authorized official phone:** (954) 262-4343

## Contact information

- **Practice address:** 650 NORTH ANDREWS AVENUE, FT. LAUDERDALE, FL 33311-7436
- **Practice address phone:** (954) 262-4100
- **Practice address fax:** (954) 262-6888
- **Mailing address:** PO BOX 290370, DAVIE, FL 33329-0370
- **Mailing address phone:** (954) 262-4397
- **Mailing address fax:** (954) 262-2269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |
| 156FX1800X | Optician | — | NULL | — |
| 156FX1800X | Optician | — | — | — |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 02/19/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078488503 | — | FL |
| 01 | — | 98673 | MEDICARE | FL |