Healthcare Provider Details

I. General information

NPI: 1851254676
Provider Name (Legal Business Name): TIMOTHY J TREGO LDO, ABOC-AC, NCLEC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 ROUTE 88
BRICK NJ
08724-3535
US

IV. Provider business mailing address

1872 ROUTE 88
BRICK NJ
08724-3535
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-1794
  • Fax: 732-785-8351
Mailing address:
  • Phone: 732-458-1794
  • Fax: 732-785-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00424300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: