Provider Demographics
NPI:1336905512
Name:DUMORNAY, RULXNER JOHN ALEX
Entity Type:Individual
Prefix:
First Name:RULXNER
Middle Name:JOHN ALEX
Last Name:DUMORNAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31A HUNT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2746
Mailing Address - Country:US
Mailing Address - Phone:857-504-5504
Mailing Address - Fax:
Practice Address - Street 1:31A HUNT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2746
Practice Address - Country:US
Practice Address - Phone:857-504-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADOP100029156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician