MEDICARE: NOVA SOUTHEASTERN UNIVERSITY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	98673A	OTHER	FL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891833661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA SOUTHEASTERN UNIVERSITY, INC

Provider Business Mailing Address
First Line	:	3200 S UNIVERSITY DRIVE
Second Line	:	SANFORD L. ZIFF BLDG. 3RD FLOOR, ROOM 4364-D
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-4343
Fax Number	:	954-262-1172

Provider Business Practice Location Address
First Line	:	1111 W BROWARD BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1638
Country	:	US
Telephone Number	:	954-525-1351
Fax Number	:	954-779-1770

Authorized Official
Title or Position	:	CONTRACTING DIRECTOR
Name	:	DR. ROSEMERY ESTEVEZ
Credential	:
Telephone Number	:	954-262-4343

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/11/2023

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Directions to “NOVA SOUTHEASTERN UNIVERSITY, INC ” Practice Location

Language	Start Address	Practice Location

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