Individual
DR. JEDEDIAH BEAL LISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
15 S RIVER RD STE 150, ST GEORGE, UT 84790-2106
(435) 465-2230
Mailing address
3450 E MAIN ST, FARMINGTON, NM 87402-5327
(505) 325-7070
(505) 325-5812
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
678
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
678
NM STATE LICENSE
NM
Enumeration date
10/17/2012
Last updated
08/26/2020
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