Provider Demographics
NPI:1356651749
Name:RIDGEWAY EYE CARE, PLLC
Entity Type:Organization
Organization Name:RIDGEWAY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIDGEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-941-3933
Mailing Address - Street 1:304 S ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2881
Mailing Address - Country:US
Mailing Address - Phone:501-941-3933
Mailing Address - Fax:501-941-3112
Practice Address - Street 1:304 S ROCKWOOD DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2881
Practice Address - Country:US
Practice Address - Phone:501-941-3933
Practice Address - Fax:501-941-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty