Provider Demographics
NPI:1548148513
Name:BOREALIS EYECARE PLLC
Entity type:Organization
Organization Name:BOREALIS EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BOUA
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:612-600-1968
Mailing Address - Street 1:5019 QUEEN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3333
Mailing Address - Country:US
Mailing Address - Phone:612-600-1968
Mailing Address - Fax:
Practice Address - Street 1:7912 SUNWOOD DRIVE, UNIT #2
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:612-600-1968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty