Individual provider Active NPI

Christy Bankston Wallace, O.D.

  • Optometrist
  • Florence, SC
National Provider Identifier
1356498547
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1087 Issued in SC
Practice address
400 N Cashua Dr
Florence, SC 29501-2098
Phone
(843) 664-9393
NPI assigned
Jan 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1087 SC Primary

Addresses

Primary practice location

400 N Cashua Dr
Florence, SC 29501-2098

Mailing address

PO Box 11407
Birmingham, AL 35246-8575
Phone (864) 359-1308

Other practice location 1

504 S 4th St
Hartsville, SC 29550-5720
Phone (843) 664-9393

Other identifiers 1

IdentifierTypeStateIssuer
D10879MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091214000224 SC Practitioner - Optometry 3971643545 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clemson Eye PAGroup PAC ID 4183537764, 51 clinicians

Practice addresses (Care Compare)

400 N Cashua Dr
Florence, SC 29501-2098
Phone (864) 654-6706

Merit-based Incentive Payment System (MIPS)

Final score
85.89 of 100Reported as group
Quality
83.39
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1087SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clemson Eye, PA Optometrist CurrentSince Oct 16, 2023 Accepting new patients
Clemson Eye, PA Optometrist CurrentSince Oct 16, 2023 Accepting new patients
Florence Primary Eye Care, PC Optometrist CurrentSince Oct 7, 2009 Accepting new patients
Clemson Eye, PA Optometrist PastSince Jun 16, 2024 Accepting new patients
Harrington Vision Center Inc II Optometrist Past Accepting new patients

Locations

15 Southern Center Ct
Easley, SC 29642
Phone (864) 722-1133

400 N Cashua Dr
Florence, SC 29501
Phone (843) 664-9398

2014 S Irby St
Florence, SC 29505
Phone (843) 292-0307

504 S 4th St
Hartsville, SC 29550
Phone (843) 332-7171

Interoperability endpoints

  • Direct secure messaging: christy.wallace.d1.p2@direct.clemsoneye.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: christy.wallace.p1@direct.clemsoneye.nextgenshare.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1356498547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352468575",
            "telephone_number": "864-359-1308",
            "fax_number": "239-496-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N CASHUA DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295012098",
            "telephone_number": "843-664-9393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "504 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Hartsville",
            "state": "SC",
            "postal_code": "295505720",
            "country_code": "US",
            "telephone_number": "843-664-9393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHRISTY",
        "middle_name": "BANKSTON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10879",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.