MEDICARE: SUSANNAH KERR MISTR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD 15669	HI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00926555	OTHER	HI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811199417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH KERR MISTR MD

Provider Business Mailing Address
First Line	:	PO BOX 383147
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-3147
Country	:	US
Telephone Number	:	808-883-3767
Fax Number	:

Provider Business Practice Location Address
First Line	:	68-1845 WAIKOLOA RD
Second Line	:	SUITE 218
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5584
Country	:	US
Telephone Number	:	808-883-3767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/02/2015

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