=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316854748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGACY EYE CARE OF NORTH CAROLINA OD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2026
-----------------------------------------------------
Last Update Date | 08/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2603 HOLLY HILL ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-5156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-228-6423
-----------------------------------------------------
Fax | 336-228-6432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1054 CARDROSS ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | JENNA RONEY
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 336-437-2544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------