Individual provider Active NPI

Calli Benedict, O.D

  • Optometrist
  • Pine City, MN
National Provider Identifier
1164007670
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3715 Issued in MN
Practice address
110 Evergreen SQ SW
Pine City, MN 55063-2000
Phone
(320) 629-7262
NPI assigned
Mar 16, 2021
Last updated
Aug 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 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 3715 MN Primary

Addresses

Primary practice location

110 Evergreen SQ SW
Pine City, MN 55063-2000

Mailing address

110 Evergreen SQ SW
Pine City, MN 55063
Phone (320) 629-7262

Other names 1

  • Calli Toler Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20210623002275 MN Practitioner - Optometry 5496156846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eagan Eye Clinic LLCGroup PAC ID 0345220745, 48 clinicians

Practice addresses (Care Compare)

110 Evergreen SQ SW
Pine City, MN 55063-2000
Phone (320) 629-7262

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3715MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Eagan Eye Clinic LLC Optometrist CurrentSince Apr 15, 2022 Accepting new patients
Eagan Eye Clinic LLC Optometrist CurrentSince Apr 15, 2022 Accepting new patients

Locations

14643 Mercantile Dr N
Ste 112
Hugo, MN 55038
Phone (651) 426-3630

110 Evergreen Sq SW
Pine City, MN 55063
Phone (320) 629-7262

3930 Cedar Grove Pkwy
Saint Paul, MN 55122
Phone (612) 454-5661

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1164007670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EVERGREEN SQ SW",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "55063",
            "telephone_number": "320-629-7262",
            "fax_number": "320-629-7747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EVERGREEN SQ SW",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550632000",
            "telephone_number": "320-629-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENEDICT",
        "first_name": "CALLI",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CALLI",
            "last_name": "TOLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pine City, MN

Sources for this page

Verify at the official NPI Registry.