=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821951062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE RIDGE VISION CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 668 FALLS BLVD N
-----------------------------------------------------
City | WYNNE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72396-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-238-3535
-----------------------------------------------------
Fax | 870-238-2427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 668 FALLS BLVD N
-----------------------------------------------------
City | WYNNE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72396-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-238-3535
-----------------------------------------------------
Fax | 870-238-2427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | DR. KURT BRAWNER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 870-318-5566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------