# NOVA SOUTHEASTERN UNIVERSITY, INC

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

## Provider details

- **NPI number:** 1891833661
- **Legal business name:** NOVA SOUTHEASTERN UNIVERSITY, INC
- **Authorized official:** DR. ROSEMERY ESTEVEZ (CONTRACTING DIRECTOR)
- **Authorized official phone:** (954) 262-4343

## Contact information

- **Practice address:** 1111 W BROWARD BLVD, FT LAUDERDALE, FL 33312-1638
- **Practice address phone:** (954) 525-1351
- **Practice address fax:** (954) 779-1770
- **Mailing address:** 3200 S UNIVERSITY DRIVE, SANFORD L. ZIFF BLDG. 3RD FLOOR, ROOM 4364-D, FT. LAUDERDALE, FL 33328-2018
- **Mailing address phone:** (954) 262-4343
- **Mailing address fax:** (954) 262-1172

## Taxonomy

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

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 07/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078488500 | — | FL |
| 01 | — | 98673A | MEDICARE GROUP NUMBER | FL |