Active NPI
Justin E Sandholm, O.D.
- Optometrist
- Montgomery, AL
National Provider Identifier
1023161791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2876
- Practice address
- 42D Medical Group
300 South Twining Street, BLDG 760
Montgomery, AL 36112-6027 - Phone
- (334) 953-5200
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2876 | CO | Primary |
Addresses
Primary practice location
42D Medical Group
300 South Twining Street, BLDG 760
Montgomery, AL 36112-6027
Mailing address
42D Medical Group
300 South Twining Street, BLDG 760
Montgomery, AL 36112-6027
Phone (334) 953-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2876 | CO | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755475200000",
"number": "1023161791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42D MEDICAL GROUP",
"address_2": "300 SOUTH TWINING STREET, BLDG 760",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361126027",
"telephone_number": "334-953-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42D MEDICAL GROUP",
"address_2": "300 SOUTH TWINING STREET, BLDG 760",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361126027",
"telephone_number": "334-953-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDHOLM",
"first_name": "JUSTIN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2025-08-18",
"certification_date": "2025-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "2876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.