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
—
—
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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