The road begins adjacent to the Niagara River at an intersection with Water Street in the village of Lewiston, Niagara County, and passes through several towns, villages, and the city of Rochester before arriving at its eastern terminus at a junction with New York State Route 370 (NY 370) southwest of Red Creek, Wayne County.

The ridge is often confused with the nearby Niagara Escarpment, which is much taller, geologic in origin, and lies a few miles to the south.

The right-of-way of Ridge Road begins on the eastern bank of the Niagara River at the intersection of Center and Water streets in the village of Lewiston.

East of this location, Ridge Road and NY 104 parallel the east–west running escarpment to its south as both entities head across western New York.

[5] Most of Ridge Road between Lewiston and the city of Rochester 70 miles (113 km) to the east passes through rural, outlying areas of Niagara, Orleans, and western Monroe counties.

[7] Once in Rochester, West Ridge Road enters areas more residential and industrial in nature, including the sprawling Eastman Business Park near the Genesee River.

NY 104 Truck leaves to the south at Hudson Avenue, the first major intersection East Ridge Road has in Irondequoit.

[9] Like in Greece, the Irondequoit portion of Ridge Road is lined with businesses ranging from big-box stores to small establishments.

State maintenance resumes one mile (1.6 km) to the east as Ridge Road merges with Empire Boulevard, which carries NY 404 into Webster from Penfield and Irondequoit.

[9][10] NY 404 takes on the Ridge Road name and heads east through the village of Webster to an intersection 0.5 miles (0.8 km) west of the Wayne County.

[citation needed] Ridge Road, in the meantime, becomes locally maintained for its remaining half-mile in Monroe County.

It briefly veers northward outside of Williamson, but returns to a more easterly routing ahead of East Townline Road and the Sodus town line.

[citation needed] At this point, CR 103 ends while Ridge Road heads eastward, becoming state-maintained again as it follows NY 88 into Sodus.

State Street itself splits two blocks later near a grade crossing with the Ontario Midland Railroad, with the eastern fork carrying the Ridge Road name.

East of the bay, Ridge Road passes through the small community of Resort before heading almost due eastward through extremely rural sections of Huron.

[citation needed][14] In Wolcott, the path of Ridge Road is known by several names as it traverses the industrial western half of the community—based around a spur of the Ontario Midland Railroad—and its residential eastern portion.

[14] Due east of Wolcott, Ridge Road intersects NY 104 for the last time in a heavily wooded area.

[16] The natural rise in the otherwise flat plains of northern Western New York was formed when sand and gravel were deposited at the shore of Glacial Lake Iroquois.

[7] The path, known as the East and West Indian Trail,[3] was initially just 15 inches (38 cm) wide; however, it was gradually widened into a dirt road in the late 18th and early 19th centuries.

[7] The trail was made passable from the Genesee River west to Lewiston in 1812; however, it was still a narrow, crude path with no bridges.

The trail was the main mode of transportation between the Genesee River and points west until the establishment of the Erie Canal in 1825, and later, railroads.

[20][21] On March 1, 1921, the mainline of Route 30 was realigned to follow Ridge Road between Ridgeway and the Rochester city line at Greece.

[30] US 104 was assigned across Upstate New York c. 1935, extending from Niagara Falls to Maple View via Lewiston, Rochester, and Oswego.

The first portion of the super two, extending from the Monroe–Wayne county line at Union Hill to west of Sodus, was opened to traffic in the mid-1940s.

In Irondequoit, the portion of the Sea Breeze Expressway (now NY 590) from Empire Boulevard to Culver Road opened in the late 1950s.