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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. ROBERT S OLLER D.O. (CEO/CLINICAL OPERATIONS)
(954) 262-4343
Entity
Organization
Contact information
Practice address
819 NE 26TH STREET, WILTON MANORS, FL 33305-1239
(954) 262-1408
(954) 262-3217
Mailing address
3200 S. UNIVERSITY DRIVE, SANFORD L. ZIFF BLDG. 3RD FLOOR, ROOM 4364-D, FT. LAUDERDALE, FL 33328-2018
(954) 262-4343
(954) 262-2269
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
NULL
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621149602
—
FL
Enumeration date
07/20/2010
Last updated
06/24/2011
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