Lakeside Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

LAKESIDE SURGERY CENTER, LLC

Practice address

6845 Isaacs Orchard Rd
Springdale, AR 72762

Phone

(473) 236-2766

NPI assigned

Jun 30, 2025

Last updated

Jun 30, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peter Marshall Daut, MDNPI 1952352106

Title

Medical Director

Phone

(479) 442-5227

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Peter M Daut, M.D.

  • Ophthalmology Physician
  • Fayetteville, AR
  • NPI 1952352106
  NPD Authorized official
• Sarah Marie Covey, M.D.

  • Ophthalmology Physician
  • Fayetteville, AR
  • NPI 1164714861
  NPD
• Paul Morriss Henry, M.D.

  • Ophthalmology Physician
  • Fayetteville, AR
  • NPI 1598745713
  NPD
• Kaitlin Spikes, O.D.

  • Optometrist
  • Fayetteville, AR
  • NPI 1992232235
  NPD
• Jennifer E Stafford, O.D.

  • Optometrist
  • Fayetteville, AR
  • NPI 1649526807
  NPD
• Carol Esther Vanscyoc, O.D.

  • Optometrist
  • Fayetteville, AR
  • NPI 1346220001
  NPD
• Cory A Vaughn, MD

  • Otolaryngology Physician
  • Springdale, AR
  • NPI 1821417833
  NPD
• Jill Lynn Robertson, O.D.

  • Optometrist
  • Park City, UT
  • NPI 1407966765
  NPD
• Karis Cheek, OD

  • Optometrist
  • Fayetteville, AR
  • NPI 1356277479
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1396634820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 E VAN ASCHE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034916",
            "telephone_number": "473-442-5227",
            "fax_number": "472-582-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6845 ISAACS ORCHARD RD",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "72762",
            "telephone_number": "473-236-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-30",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "DAUT",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "479-442-5227",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shealtiel Blu Kuykendall, LCSW
• Kyle W. Harris DDS. PLLC
• Jessica Lagrone, CD, CCE, MAT
• Ashley D Lahue
• Landry Laird, PT, DPT
• Anjana Lal, M.D.
• Faith Lalimo
• Kimberly Lamb
• Samantha Lambert, OTR/L
• Leslie Lancaster-Smith, M.S. CCC-SLP

• Ambulatory Surgical Clinic/Center in Springdale, AR
• Providers in Springdale, AR by specialty
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.