Robert Brian Wallace, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

SC1088 Issued in SC

Practice address

2014 S Irby St
Florence, SC 29505-3420

Phone

(843) 679-9005

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Optometry

Education

Southern College of Optometry, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harrington Eye Center, LLCGroup PAC ID 9931519006, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Florence Primary Eye Care, PC

  • Optometrist
  • Florence, SC
  • NPI 1134169147
  Medicare reassignment NPD Authorized official
• Harrington Eye Center LLC

  • Optometrist
  • Florence, SC
  • NPI 1427432301
  Medicare reassignment Care Compare group NPD
• Harrington Eye Center LLC

  • Optometrist
  • Florence, SC
  • NPI 1043307861
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609819952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 MADISON AVE",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014528",
            "telephone_number": "843-661-5063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 S IRBY ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295053420",
            "telephone_number": "843-679-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "SC1088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10888",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christy Bankston Wallace, O.D.
• Jasmika Wallace
• Kelsey Wallace
• Lisa M. Wallace, FNP
• Mandy L Wallace, MSRPT
• Sara Davis Wallace, FNP-BC
• Jazzmine Walley
• Sharon A Walters, FNP
• Walton Accident & Injury Clinic, LLC
• Walton Accident Clinic, LLC

• Optometrist in Florence, SC
• Providers in Florence, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.