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General NPI Number Information
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NPI Number | 1548148513
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Entity Type | Organization
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Legal Business Name | BOREALIS EYECARE PLLC
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 7912 SUNWOOD DRIVE, UNIT #2
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City | RAMSEY
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State | MN
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Zip | 55303
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Country | US
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Telephone | 612-600-1968
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Fax |
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Provider Business Mailing Address
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Address Line | 5019 QUEEN AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55430-3333
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Country | US
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Telephone | 612-600-1968
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. TIMOTHY BOUA YANG
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Credential | OD
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Telephone | 612-600-1968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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